Efficacy and safety of pregnant women with chronic hepatitis B receiving nucleos(t)ide analogs therapy: a network meta-analysis

Abstract

Objective Reducing mother-to-child transmission(MTCT)of hepatitis B virus(HBV) is one of the key ways to eliminate hepatitis B. Although studies have demonstrated the effectiveness of oral nucleos(t)ide analogs(NAs),drug’s comparisons are lacking. The network meta-analysis aims to comprehensively compare and summarize the efficacy and safety of the three drugs (Lamivudine(LAM), Telbivudine(TBV) and Tenofovir(TDF)), providing a basis for drug selection. Methods A comprehensive retrieval of data was conducted from PubMed (Medline), Web of Science, the Cochrane Library, EMBASE, CNKI and SinoMed through to December 2019. We performed pair-wise meta-analysis and Bayesian network meta-analysis to compare the efficacy and safety of NAs. Results A total of 35 studies whith involving a total of 6,109 pregnant women with HBV infenction were selected. All three drugs can effectively block MTCT and improve HBV DNA suppression (p < 0.05). No significant differences were found in the occurrence of adverse events in mothers and infants.The results of the network meta analysis showed that the possibility of TBV and TDF being the best drug was 50% and 46%, the possibility of TBV and TDF being the second is the same-45%, the possibility of LAM being the worst drug is 85%. Conclusion LAM, TBV and TDF are effective in preventing MTCT of HBV in women with chronic HBV infection with high viral load. Using them does not seem to increase the probability of adverse events in pregnant women and infants. It cannot be ignored that TDF and TBV appear to show better blocking effects in clinical practice.