Potential Effects of Telbivudine Versus Entecavir on Renal Function in Patients With Chronic Hepatitis B Virus Receiving Glucocorticoids Therapy

Abstract

Data remains limited about the optimal nucleos(t)ide analogue therapy for patients infected with hepatitis B virus (HBV) while treated with glucocorticoids because of kidney diseases. We aim to evaluate the safety and efficacy of long‐term antiviral therapy with telbivudine (LdT) and entecavir (ETV) in this specific population. In this prospective randomized controlled study, a total of 60 patients with both kidney diseases and chronic hepatitis B were randomly divided into LdT group and ETV group. We analyzed changes in estimated glomerular filtration rate (eGFR), variation in HBV DNA, seroconversion of hepatitis B e antigen (HbeAg) and hepatitis B surface antigen (HBsAg). During the 18 month follow‐up period, serum HBV DNA load was decreased significantly at 3, 6, 12, 18 months, compared to the pre‐treatment value in both LdT and ETV cohorts. No patients achieved HBeAg loss‐seroconversion or HBsAg loss‐seroconversion with ETV therapy whilst one patient experienced HBeAg and HBsAg loss‐seroconversion with LdT therapy. No significant changes in eGFR were seen in patients with ETV therapy compared to baseline. However, eGFR increased 7.43, 18.97 mL/min/1.73m2, respectively at 12 and 18 months in LdT group and the changes were significant compared to baseline. Further analysis also demonstrated that eGFR significantly improved 11.8, 23.25 mL/min/1.73m2 at 12 and 18 months in LdT group for patients with impaired renal function. LdT is superior to ETV in patients with chronic hepatitis B and kidney diseases because of the renal protection it confers by increasing eGFR.

Association between serum Cystatin C and renal injury in patients with chronic hepatitis B

“…[ 1 ] Studies have reported that patients with chronic hepatitis B (CHB) and liver cirrhosis have different degrees of renal injury as the disease progresses. [ 2 , 3 ] A variety of mechanisms can induce renal function injury in patients with CHB. [ 4 ] Studies have reported that, after the hemodynamic changes, renal injury will further reduce the glomerular filtration rate (GFR) and therefore increase the mortality rate.…”

Comparison of renal safety of Telbivudine and Entecavir in Chronic Hepatitis B patients with renal impairment: A meta-analysis

“…The study selection process is summarized in Figure 1.We identi ed 6102 relevant studies though database searches,After the initial screening and eligibility assessment phase,1972 redundant publications were excluded and, after referring to the titles and abstracts,a further 41 studies that not ful lling the inclusion criteria were rejected. The remaining 4 studies without su cient data were rejected, Finally,7 studies were enrolled in this meta-analysis.Five of the articles were retrospective cohort analyse [13][14][15][16][17] and two was an RCTs [18,19].A total of 1088 patients, 522 of whom were treated with LdT and 566 with ETV were included in this meta-analysis.The LdT dose used in the studies was 600 mg/day and that of ETV was 0.5 mg/day. Table 1 summarizes the basic characteristics of the included studies and patients .Three of the included studies were from mainland, China [13,16,19].…”

“…The remaining 4 studies without su cient data were rejected, Finally,7 studies were enrolled in this meta-analysis.Five of the articles were retrospective cohort analyse [13][14][15][16][17] and two was an RCTs [18,19].A total of 1088 patients, 522 of whom were treated with LdT and 566 with ETV were included in this meta-analysis.The LdT dose used in the studies was 600 mg/day and that of ETV was 0.5 mg/day. Table 1 summarizes the basic characteristics of the included studies and patients .Three of the included studies were from mainland, China [13,16,19]. {Liu, 2019 #27;Yan, 2012 #37;Qi, 2015 #47}two studies from Taiwan, China [14,15], one studies from Korea [17] and one study from worldwide [18].…”