Comparison of tenofovir and entecavir on the risk of hepatocellular carcinoma and mortality in treatment-naïve patients with chronic hepatitis B in Korea: a large-scale, propensity score analysis

Abstract

ObjectiveThe use of tenofovir (TDF) and entecavir (ETV) in patients with chronic hepatitis B (CHB) has led to a decrease in the incidence of hepatocellular carcinoma (HCC) and liver-related events. However, whether there is a difference between the two agents in the extent of improving such outcomes has not been clarified thus far. Therefore, we aimed to compare TDF and ETV on the risk of HCC and mortality.DesignA total of 7015 consecutive patients with CHB who were treated with TDF or ETV between February 2007 and January 2018 at the liver units of the Catholic University of Korea were screened for study eligibility and 3022 patients were finally analysed. Study end points were HCC and all-cause mortality or liver transplantation (LT) within 5 years after the initiation of antiviral therapy. Propensity score matching (PSM) and inverse probability of treatment weighting methods were used.ResultsNo difference was observed between TDF and ETV in the incidence rates of HCC in the entire cohort (HR 1.030; 95% CI 0.703 to 1.509, PSM model, p=0.880) and subgroups of patients with chronic hepatitis and cirrhosis. Also, no difference was observed between TDF and ETV in the incidence rates of all-cause mortality or LT in the entire cohort (HR 1.090; 95% CI 0.622 to 1.911, PSM model, p=0.763), and patients with chronic hepatitis and cirrhosis.ConclusionThis study has demonstrated the clinical outcomes in patients with CHB who received TDF or ETV treatment. There was no difference in the intermediate-term risk of HCC and mortality or LT between the two drugs.

Tenofovir Treatment Has Lower Risk of Hepatocellular Carcinoma than Entecavir Treatment in Patients with Chronic Hepatitis B: A Systematic Review and Meta-Analysis

“…Furthermore, 790 irrelevant records were excluded during the title and/or abstracts screening step. In the full-text screening, 14 studies did not meet our inclusion criteria and were therefore excluded from the meta-analysis, leaving 7 studies containing 35,785 participants were ultimately included in this metaanalysis [10][11][12][16][17][18][19].…”

“…All studies were published between 2017 and 2019. One study was performed in China [16], 4 in Korea [10][11][12]17], 1 in Taiwan [18], and 1 was an international, multicentric cohort study [18]. All studies had a retrospective cohort design with a mean length of follow-up of 4 years, with a range from 3.2 ,807 patients used TDF and ETV as nucleos(t)ide analogue therapy, respectively.…”

“…In the absence of controlled comparisons of these 2 agents, real-world evidence is emerging, albeit inconsistently, of differential rates of development of HCC between ETV-and TDF-based regimens. The very recent publication of several studies in this area [9][10][11][12] and the retraction and replacement of a large study [11], with an updated analysis, merit the conduct of an up-to-date review of this research question.…”

Letter: is tenofovir superior to entecavir for hepatocellular carcinoma prevention in chronic hepatitis B?

“…We identified six cohort studies with large sample sizes which fulfilled our inclusion criteria. [3][4][5][6][7][8] Participants of one study were from Hong Kong, 3 and those of the other four studies were from Korea. 4,[6][7][8] The last cohort study analyzed an international consortium that encompassed 19 centres from six countries or regions (United States, n = 5; China, n = 3; Hong Kong, n = 2; Japan, n = 4;…”

“…All these six retrospective cohort studies composed of treatment-naïve CHB patients treated with either TDF or entecavir monotherapy. [3][4][5][6][7][8] The follow-up duration ranged from 32.0 to 69.9 months. The overall incidence rate of HCC was In conclusion, this meta-analysis revealed that TDF was superior to entecavir monotherapy for HCC prevention in CHB.…”