The comparison of different antiviral therapies on the prognosis of hepatitis B virus-related hepatocellular carcinoma after curative treatments

Xia, Zijing; He, Ling; Xiong, Li; Wen, Tianfu

doi:10.1097/md.0000000000020877

Cited by 7 publications

(8 citation statements)

References 49 publications

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“…However, previous studies have been highly heterogeneous in terms of baseline characteristics, follow-up duration, use of other NAs, and statistical methodology, making it difficult to make objective comparisons. Similarly, previous meta-analyses [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] have also failed to reach an agreement owing to the following limitations: pooled analysis of odds ratios with different follow-up durations [ 21 ], a mix of antiviral naïve and non-naïve patients, and pooled analysis of hazard ratios (HRs) using retrospective hospital cohort data and administrative databases or claim data at once. These inconsistent statistical methodologies of the previous studies were pointed out in a recent review article [ 22 ].…”

Section: Introductionmentioning

confidence: 52%

Systematic Review with Meta-Analysis: Comparison of the Risk of Hepatocellular Carcinoma in Antiviral-Naive Chronic Hepatitis B Patients Treated with Entecavir versus Tenofovir: The Devil in the Detail

Lee

Kim

et al. 2022

Cancers

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Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) are the preferred anti-viral agents used as first-line treatments for chronic hepatitis B (CHB). However, the efficacy of these agents in reducing the incidence of hepatocellular carcinoma (HCC) remains unclear. We conducted this meta-analysis to assess the efficacy of anti-viral agent on preventing HCC in CHB. Two investigators independently searched all relevant studies that examined the efficacy of anti-viral agent for preventing HCC using MEDLINE, Embase, and Cochrane Library databases through August 2021. The extracted data were analysed using a random-effects meta-analysis model based on the inverse-variance method (DerSimonian–Laird) and expressed as hazard ratio (HR) and 95% confidence interval (95% CI). We included 19 retrospective studies in the analysis. Although there was substantial heterogeneity between the studies, the overall pooled HR indicated that TDF significantly lowered the risk of HCC (HR: 0.72, 95% CI: 0.58–0.90, I2 = 66.29%). However, the pooled analysis of propensity score (PS)-matched subpopulations showed no significant differences (HR, 0.83; 95% CI, 0.65–1.06; I2 = 52.30%) between TDF and ETV. In a subgroup analysis, an interval of over three years in the start point of patient enrolment and excluding alcoholic liver disease patients significantly lowered the HCC risk associated with TDF. In conclusion, TDF may be more effective than ETV at reducing HCC incidence in treatment-naive CHB patients, but this effect was not consistent in the PS-matched subpopulation that reduced heterogeneity. As a result of subgroup analysis, the conflicting findings of previous studies may result from heterogeneous inclusion criteria. Further studies with standardised protocols are needed to reduce the residual heterogeneity.

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Section: Introductionmentioning

confidence: 52%

Systematic Review with Meta-Analysis: Comparison of the Risk of Hepatocellular Carcinoma in Antiviral-Naive Chronic Hepatitis B Patients Treated with Entecavir versus Tenofovir: The Devil in the Detail

Lee

Kim

et al. 2022

Cancers

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“…Our early study suggested that serum hepatitis B virus DNA level is tightly linked with postresection tumour recurrence in CHB patients, 6 and effective antivirals may significantly improve overall survival by suppressing tumour recurrence and restoring liver functional reserve. 7 In summary, selection of primary end point, detection of MVI, and the usage of antivirals are critical issues in surgical HCC studies. Providing accurate information is expected to play an important role in improving patient management and prognostic prediction for HCC.…”

Section: E T T E R T O T H E E D I T O R Nomogram For Surgical Hepatocellular Carcinoma: What Have We Missed?mentioning

confidence: 99%

“…Lastly, 85% of patients in Zeng et al's series had chronic hepatitis B (CHB), but the information of specific antiviral therapy (either pre or post‐operatively) was not mentioned. Our early study suggested that serum hepatitis B virus DNA level is tightly linked with post‐resection tumour recurrence in CHB patients, 6 and effective antivirals may significantly improve overall survival by suppressing tumour recurrence and restoring liver functional reserve 7 . In summary, selection of primary end point, detection of MVI, and the usage of antivirals are critical issues in surgical HCC studies.…”

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confidence: 97%

Nomogram for surgical hepatocellular carcinoma: What have we missed?

Huo

2021

Liver International

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“…However, comparison of efficacy between ETV and TDF is still controversial. It is reported in a large proportion of studies including comparative studies and meta-analysis that TDF and ETV are comparable in treatment response, preventing occurrence of hepatocellular carcinoma and safety (20)(21)(22)(23)(24)(25)(26). A small number of studies suggest otherwise.…”

Section: Introductionmentioning

confidence: 99%

Tenofovir Disoproxil Fumarate Is Superior to Entecavir in Reducing Hepatitis B Surface Antigen for Chronic Hepatitis B in China: 2-Year Comprehensive Comparative Result of a Matched Comparative Study

Yang

Cai

et al. 2021

Front. Med.

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Aim: Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) are equally recommended as the first-line antiviral treatments for chronic hepatitis B (CHB) at present. We aimed to compare the long-term efficacy and safety between ETV and TDF therapy in CHB patients who had not received nucleoside analog treatment.Method: In this single-center retrospective study, 414 patients who received ETV (290 patients) or TDF (124 patients) therapy at our center from January 2017 to May 2019 were included. To reduce the imbalance of baseline variables, propensity score matching (PSM) was employed to yield 124 pairs of patients at a ratio of 1:1 based on the treatment regimen.Result: After PSM, the cumulative rate of patients who achieved complete virological response (CVR) was not different by drug therapy at each inspection time (1, 3, 6, 12, 18, and 24 months). Subgroup analysis on HBeAg status and level of HBV DNA demonstrated that evolution of proportion of achieving CVR was not significantly different between groups. Despite the insignificant incidence of HBsAg seroclearance in either group, patients in TDF group achieved higher on-treatment HBsAg decline at each inspection time (1, 3, 6, 9, 12, 18, and 24 months), 0.39, 0.51, 0.61, 0.64, 0.68, 0.76, and 0.91 log IU/mL, respectively; while the corresponding reduction were 0.27, 0.37, 0.40, 0.45, 0.48, 0.55, and 0.66 log IU/mL in ETV group (p < 0.05). In subgroup analysis, we found that the significant difference still existed in patients with high baseline HBsAg level (>3 log IU/mL). Additionally, the proportion of patients who achieved on-treatment HBsAg decline >1 log IU/mL in TDF and ETV group was 33.3 and 17.1% (p < 0.01) at the 12th month, 44.4 and 29.5% (p = 0.03) at the 24th month, respectively. Mean increase in serum creatinine from baseline was 0.10 and 0.08 mg/dL in TDF and ETV group (p = 0.11), with no patient experienced acute kidney injury.Conclusions: TDF has higher potency in reducing HBsAg than ETV in this study. Considering the effect still existed in patients with high HBsAg level (>3 log IU/mL), TDF might be a superior therapeutic regimen combining with its relatively safety.

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The comparison of different antiviral therapies on the prognosis of hepatitis B virus-related hepatocellular carcinoma after curative treatments

Abstract: Supplemental Digital Content is available in the text

Cited by 7 publications

References 49 publications

Systematic Review with Meta-Analysis: Comparison of the Risk of Hepatocellular Carcinoma in Antiviral-Naive Chronic Hepatitis B Patients Treated with Entecavir versus Tenofovir: The Devil in the Detail

Systematic Review with Meta-Analysis: Comparison of the Risk of Hepatocellular Carcinoma in Antiviral-Naive Chronic Hepatitis B Patients Treated with Entecavir versus Tenofovir: The Devil in the Detail

Nomogram for surgical hepatocellular carcinoma: What have we missed?

Tenofovir Disoproxil Fumarate Is Superior to Entecavir in Reducing Hepatitis B Surface Antigen for Chronic Hepatitis B in China: 2-Year Comprehensive Comparative Result of a Matched Comparative Study

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