Efficacy and safety of antiviral treatment on blocking the mother‐to‐child transmission of hepatitis B virus: A meta‐analysis

Song, Jiahui; Yang, Fan; Wang, Shuo; Tikande, Sakinatou; Deng, Yang; Tang, Weina; Cao, Guangwen

doi:10.1111/jvh.13036

Cited by 30 publications

(29 citation statements)

References 39 publications

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“…A meta‐anlysis 19 comparing lamivudine, telbivudine and tenofovir did not show any statistically significant difference in the three antivirals. Telbivudine and tenofovir are currently rated pregnancy category B, and lamivudine pregnancy category C, by the US Food and Drug Administration based primarily on animal data, with no clear evidence of harm in sparse human data.…”

Section: Management Of the Pregnant Mother To Reduce Mtctmentioning

confidence: 85%

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Abstracts

Bourlière

Pol

2019

Liver International

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These proceedings of the PHC 2019 reflect the remarkable recent advances in all fields of hepatology that are covered during this conference.Thirty years after the discovery of the hepatitis C virus (HCV), we can tell our patients that they have almost a 100% chance of cure with pangenotypic DAAs. The rare patients who relapse with resistanceassociated substitutions after DAAs therapy are cured with appropriate retreatment. Cure means eradication of HCV infection with improved quality of life and outcome. Although the WHO HCV program, which seeks the elimination of hepatitis C by 2030 may be difficult to achieve, it is accompanied by active national programs worldwide.We can tell our patients with hepatitis B that they have a 100% chance of viral suppression. Long term studies of patients receiving last generation NUCs demonstrate sustained remission without resistance, regression of liver lesions and improved outcome. WHO has set priorities to achieve global goals including more effective vaccination and easy access to therapy programs. The next objective is a cure. This objective becomes realistic with the development of effective drugs of different viral targets. Future treatment will certainly include combinations that are adapted to the different phases of hepatitis B. Patients with hepatitis delta can be told that new treatments are on the way. Ongoing phase 3 trials of Myrcludex and Lonafarnib should confirm their efficacy, which is synergistic in combination with interferon.Patients with NAFLD must be receiving counselling. However, in this emerging liver disease, which affects 25% of the population, | 2421 ABSTRACT life style counselling is only effective in a minority of patients. As we learned from NANB hepatitis before discovering the HCV, our lack of knowledge explains the problems we now face with NAFLD.The key issue is differentiating NASH from simple steatosis. There is An alternative option is the combination of SOF plus GLE/ PIB ± RBV for 12-16 weeks. Moreover, triple FDC is recommended either in combination with weight-based dose RBV and/ or to extend treatment to 16 or 14 weeks in very difficult-to-cure patients with NS5A RASs who have failed to achieve SVR twice after several DAAs regimens including protease and/or N5A inhibitors. SUMMARYIn conclusion, the single pill triple FDC SOF/VEL/VOX for 12 weeks or the triple combination SOF plus GLE/PIB with or without ribavirin for 12 weeks achieves a 96% SVR rate in the few patients who fail DAAs combinations, even the most recent pangenotypic regimens.Therefore, with the current available rescue regimens, DAAs treatment failure is no longer significant issue.

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Section: Management Of the Pregnant Mother To Reduce Mtctmentioning

confidence: 85%

“…A meta analysis has shown a significant reduction in MTCT of HBsAg with nucleos(t)ide analogues with a RR = 0.51, 95% CI 0.45‐0.57 19 . This is now recommended in all guidelines.…”

Section: Management Of the Pregnant Mother To Reduce Mtctmentioning

confidence: 99%

Abstracts

Bourlière

Pol

2019

Liver International

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“…Another meta-analysis showed all recommended agents have a great effect on preventing vertical transmission of HBV and second trimester was the better timing of initiating AVT in the subgroup analysis of HBV DNA/HBsAg positivity [48]. Major of them were based on the pair-wised meta-analysis [6,48]. Therefore, different from existing studies, our network analysis has some following remarkable characteristics.…”

Section: Discussionmentioning

confidence: 97%

“…Brown et al recommended the use of these agents in female who are HBeAg positive and high level of HBV DNA in the third trimester to prevent MTCT [6]. Another meta-analysis showed all recommended agents have a great effect on preventing vertical transmission of HBV and second trimester was the better timing of initiating AVT in the subgroup analysis of HBV DNA/HBsAg positivity [48]. Major of them were based on the pair-wised meta-analysis [6,48].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of antiviral therapy for HBV in different trimesters of pregnancy: systematic review and network meta-analysis

Liu

Feng

et al. 2020

Hepatol Int

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Background Several antiviral agents licenced for blocking mother-to-child transmission (MTCT) of HBV, but their relative efficacy beginning from different trimesters has scarce been evaluated. We aimed to conduct a network meta-analysis to statistically differ the efficacy and safety of each antiviral agents initiating on different timings in preventing mother-to-infant transmission of HBV. Methods Studies were included from PubMed, EMBASE, Web of Science, and Cochrane databases through July 1, 2019. Eligible studies recruited randomized controlled trials and nonrandomized studies reporting about infant or/and maternal efficacy and safety outcomes and were screened by two investigators independently. Extracted data were analyzed by pairwised and network meta-analysis, respectively. Results 3 Randomized and 32 nonrandomized studies enrolling 6738 pregnant female were included. Using network analysis, any antiviral agent interrupted HBV vertical transmission much more effectively than placebo. No agent showed significant efficacy different from others, but a strong trend toward significance was found in telbivudine and tenofovir, of which had the highest probability of being ranked the first-or second-best treatment for reducing MTCT of HBV. The treatment applied in the first and second trimester had a similar efficacy in preventing MTCT. Compared with the initiation during the third trimester, lower rate of MTCT was revealed when antiviral therapy was administrated before third trimester, (RR = 0.045, 95% CI 0.0053 to 0.20); a similar effect at delivery on suppressing maternal HBV DNA level and converting serum HBeAg were achieved if the timing of antiviral treatment started prior, but an obvious improvement of normalizing ALT flare was calculated out; no statistically differences among maternal and fetal safety outcomes were found if mothers received antiviral agents before pregnant 28 weeks. Conclusion This network meta-analysis recommended the earlier use of telbivudine or tenofovir, tends to be better to prevent MTCT of HBV in pregnancy with no increased adverse maternal or fetal outcomes.

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“…Although TDF is detected in breast milk, it has low oral bioavailability, and infants are exposed to minimal oral concentrations (<0.03% of recommended neonatal dose) . In nonpregnant patients with CHB, long‐term TDF therapy is linked to metabolic bone disease and renal dysfunction, but to date no significant maternal safety concerns have been reported with NA therapy during pregnancy . A new formulation of TDF (tenofovir alafenamide fumarate [TAF]) was recently approved for treatment of CHB and human immunodeficiency virus (HIV) infection.…”

Section: Epidemiology Of Hbv and Mtctmentioning

confidence: 99%

Hepatitis B and Pregnancy: Virologic and Immunologic Characteristics

Joshi

Coffin

2020

Hepatol Commun

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The hepatitis B virus (HBV) is an important human pathogen. Unvaccinated infants infected through mother-to-child transmission (MTCT) are at >95% risk of developing serum hepatitis B surface antigen-positive chronic hepatitis B (CHB). Despite complete passive-active HBV immunoprophylaxis, approximately 10% of infants born to mothers who are highly viremic develop CHB, and thus maternal treatment with nucleos(t)ide analogs (tenofovir disoproxil fumarate, lamivudine, or telbivudine) is recommended in the third trimester of pregnancy to reduce MTCT risk. Viral rebound usually occurs after stopping treatment and, in the context of maternal immunologic reconstitution postpartum, can also precipitate host immune-mediated hepatic (biochemical) flares. In this article, we review the epidemiology of HBV MTCT, discuss management and potential mechanisms of HBV vertical transmission, and highlight recent studies on virologic and immunologic aspects of hepatitis B in pregnancy and postpartum. (Hepatology Communications 2020;4:157-171).The global prevalence of CHB (serum HBsAg+) is 3.6%, with the highest prevalence in Africa (8.8%) and the Western Pacific (5.2%). More than 75% of individuals with CHB worldwide are found in the Asia Pacific

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Efficacy and safety of antiviral treatment on blocking the mother‐to‐child transmission of hepatitis B virus: A meta‐analysis

Cited by 30 publications

References 39 publications

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Efficacy and safety of antiviral therapy for HBV in different trimesters of pregnancy: systematic review and network meta-analysis

Hepatitis B and Pregnancy: Virologic and Immunologic Characteristics

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