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PTH-107 Chronic Hepatitis B Management The UK: A National Survey of Current Practice Following Nice Guidance
  1. N Hansi1,
  2. P Troke2,
  3. US Gill1,
  4. K Agarwal3,
  5. M Aldersley4,
  6. S Al-Shamma5,
  7. A Brown6,
  8. J Cobbold7,
  9. P Collins8,
  10. A Fowell9,
  11. W Gelson10,
  12. A Holt11,
  13. S McPherson12,
  14. M Phillips13,
  15. M Prince14,
  16. P Richardson8,
  17. S Ryder15,
  18. S Singhal16,
  19. B Stone17,
  20. A Ustianowski18,
  21. J Vilar18,
  22. L Walker12,
  23. T Wong19,
  24. P Kennedy1
  1. 1Hepatology Unit, Centre of Immunobiology, Blizard Institute, Barts and The London SMD, QMUL
  2. 2Gilead Sciences Limited
  3. 3Institute of Liver Studies, King’s College Hospital, London
  4. 4Hepatology, St James Hospital, Leeds
  5. 5Hepatology, Royal Bournemouth Hospital, Bournemouth
  6. 6Hepatology, Imperial College, St Mary’s Hospital, London
  7. 7Hepatology, John Radcliffe Hospital, Oxford
  8. 8Hepatology, Bristol Royal Infirmary, Bristol
  9. 9Hepatology, Queen Alexandra Hospital, Portsmouth
  10. 10Hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge
  11. 11Hepatology, Queen Elizabeth Hospital, Birmingham
  12. 12Hepatology, Freeman Hospital, Newcastle
  13. 13Hepatology, Norfolk and Norwich University Hospital, Norwich
  14. 14Hepatology, Manchester Royal Infirmary, Manchester
  15. 15Hepatology, Nottingham University Hospital, Nottingham
  16. 16Hepatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham
  17. 17Hepatology, Royal Hallamshire Hospital, Sheffield
  18. 18Infectious Diseases, North Manchester General Hospital, Manchester
  19. 19Hepatology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Abstract

Introduction National Institute for Health and Care Excellence (NICE) published guidance on the management of chronic hepatitis B (CHB) in June 2013 (NICE 165). Where antiviral therapy was indicated, NICE recommended 48 weeks Peg-interferon alfa-2a (PegIFNα) as first-line treatment in compensated disease and early discontinuation of PegIFNα based on stopping rules. Nucleos(t)ide analogues were recommended as second-line therapies. This survey was undertaken to capture current CHB practice management across the UK following NICE 165 and report PegIFNα use, and review the availability/utility of quantitative HBsAg.

Methods This was a UK-wide national multicentre study, where 25 CHB treatment centres were invited to complete a qualitative questionnaire of CHB practice. Clinical practice in the 12 months preceding NICE 165 was compared with CHB management in the immediate 12 months post publication.

Results All centres participating undertook a multi-disciplinary approach to the treatment of CHB patients, with 75% of centres adopting joint consultant-nurse led clinics. Interim analysis of the data revealed that 73% of centres consider PegIFNα as first line therapy in eAg+ disease, compared with 40% in eAg- disease. Importantly, there was no difference in the use of PegIFNα, irrespective of eAg status, prior to and following the publication of NICE 165 (p = 0.82). Of those patients treated with PegIFNα as first line-therapy, 63% of them, to date, required second line therapy with NUCs due to treatment failure.

Conclusion This UK survey demonstrates that current practice has not significantly changed following NICE 165. While most centres adopt a multi-disciplinary approach, the UK guidance on CHB has not been widely adopted. Barriers to this may include the limited availablilty of qHBsAg in UK centres, but more likely this relates to Physician preference for the continued use of NUCs as first-line therapy of choice.

Disclosure of Interest N. Hansi: None Declared, P. Trok, None Declared, U. Gill: None Declared, K. Agarwal: None Declared, M. Aldersley: None Declared, S. Al-Shamma: None Declared, A. Brown: None Declared, J. Cobbold: None Declared, P. Collins: None Declared, A. Fowell: None Declared, W. Gelson: None Declared, A. Holt: None Declared, S. McPherson: None Declared, M. Phillips: None Declared, M. Prince: None Declared, P. Richardson: None Declared, S. Ryder: None Declared, S. Singhal: None Declared, B. Stone: None Declared, A. Ustianowski: None Declared, J. Vilar: None Declared, L. Walker: None Declared, T. Wong: None Declared, P. Kennedy Grant/research support from: Gilead Sciences

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