The efficacy and safety comparison between tenofovir and entecavir in treatment of chronic hepatitis B and HBV related cirrhosis: A systematic review and Meta-analysis
Introduction
Hepatitis B virus (HBV) infection will cause chronic hepatitis B (CHB), a difficult problem for centuries. The earliest human virus isolation known so far was obtained by laparoscopic liver biopsy from a Korean mummy in the sixteenth century [1]. And to date, HBV infection has already become a global problem. Till 2010, 248 million individuals have been reported the hepatitis B surface antigen (HBsAg) positive, and despite the availability of an effective vaccine, the virus causes about 780,000 deaths every year [1], [2]. HBV carriers present a broad spectrum ranging from asymptomatic carrier state to liver cirrhosis and hepatocellular carcinoma [3]. It's estimated that about 15% to 30% of chronic hepatitis B virus (HBV) carriers in the world are at the increasing risks for developing liver cirrhosis and complicated end-staged liver disease [4].
The approved and widely used agents to treat CHB are conventional interferon alfa and pegylated interferon-alfa-2a as well as the nucleoside analogs (lamivudine, entecavir, and telbivudine) and the nucleotide analog (adefovir, dipivoxil and tenofovir) [5]. Evidence shows that entecavir and tenofovir have low incidence of drug-resistant mutants and side effects, moreover, the current guidelines recommend that the most common potent drugs to treat CHB and liver cirrhosis are nucleoside analog entecavir (ETV) and the nucleotide analog tenofovir (TDF) [6], [7]. However, the difference of efficacy and the safety between ETV and TDF is under debating. And which one is the best to treat CHB and CHB related cirrhosis in different treatment duration remains unclear. Besides, whether there's any difference regarding the safety between TDF and ETV is not well concluded.
Therefore, the study aims to evaluate the efficacy and safety between tenofovir and entecavir in the treatment of CHB and HBV related cirrhosis through Meta-analysis.
Section snippets
Article retrieval
The retrieval sources include PubMed, the Cochrane Library, Nature, China National Knowledge Infrastructure (CNKI) and WanFang Data. The key words were the combination of (“Tenofovir” and “Entecavir”) and (“Chronic Hepatitis B” or “CHB”) and “Liver cirrhosis”. All human studies were included and no publish time lower limit (up to May 12, 2016) was taken. We also searched articles through relevant citations in related literature.
Inclusion and exclusion criteria
Any article which conforms to the under-mentioned criteria would be
Article selection
After searching the electronic databases and selecting the relevant citations, we obtained 572 reports and 17 studies respectively. 422 articles were ruled out because of irrelevance. After reading full-text of 167 articles, 141 articles were excluded due to meet the exclusion criteria. 26 articles were combined into qualitative description (12 [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22] articles evaluated TDF and ETV in CHB patients, 6 [23], [24], [25], [26], [27],
Discussion
We found that there's significant difference in comparing TDF with ETV in short-term follow up period (RR = 1.43, 95%CI: 1.06–1.94, I2 = 0.0%; P < 0.017 and RR = 0.89, 95%CI: 0.81–0.97, I2 = 0.0%; P < 0.017 for month 3 and month 6, respectively) but no significant difference in long-term follow up period (RR = 0.96, 95%CI: 0.90–1.02, I2 = 10.4%; P > 0.017 and RR = 0.97, 95%CI: 0.92–1.02, I2 = 0.0%; P > 0.017 for 12 months and 24 months, respectively) which indicated that in 3 month duration of treatment, TDF users might
Conclusion
TDF has a better efficacy than ETV in 3 months treatment duration, but intriguingly, TDF might not better than ETV during the 6 months treatment period in the viral suppression and liver function improvement. There's no significant difference between TDF and ETV in the long-term treatment duration and in the treatment of HBV related liver cirrhosis. Both TDF and ETV could influence renal function but patients under TDF therapy may have more risk to suffer from renal damage and hypophosphatemia.
Conflict of interests
The authors declare that they have no competing interests.
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Comparison of renal safety and bone mineral density of tenofovir and entecavir in patients with chronic hepatitis B: a systematic review and meta-analysis
2022, International Journal of Infectious DiseasesCitation Excerpt :To the best of our knowledge, four systematic reviews have compared the efficacy and safety of TDF and ETV. Among them, Ke et al. (2014) and Han et al. (2017) focused on efficacy rather than renal safety. Ke et al. (2014) did not find a significant difference in the safety between the two drugs, whereas Han et al. (2017) suggested that patients treated with TDF may have underlying renal impairment compared with those treated with ETV.
Asociación Mexicana de Hepatología A.C. Clinical guideline on hepatitis B
2021, Revista de Gastroenterologia de MexicoEstimating the proportion of people with chronic hepatitis B virus infection eligible for hepatitis B antiviral treatment worldwide: a systematic review and meta-analysis
2021, The Lancet Gastroenterology and HepatologyCitation Excerpt :WHO also estimates that in 2015, 887 000 people died of chronic HBV infection worldwide.1 Antiviral agents suppress HBV replication, prevent progression to cirrhosis, and reduce the risk of hepatocellular carcinoma and liver-related deaths.3 In 2015, WHO produced its first guidelines on prevention, care, and management of chronic HBV infection, with a focus on low-income and middle-income countries.4