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Abstract Details
Comparative Effectiveness of Entecavir vs Tenofovir for Preventing Hepatocellular Carcinoma in Patients With Chronic Hepatitis B: A Systematic Review and Meta-analysis
Hepatology. 2020 Apr 10. doi: 10.1002/hep.31267. Online ahead of print.
Shravan Dave1, Sooyoung Park12, M Hassan Murad3, Abbey Barnard1, Larry Prokop4, Leon A Adams5, Siddharth Singh1, Rohit Loomba
Author information
1Division of Gastroenterology, Department of Medicine, University of California at San Diego, San Diego, USA.
2Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kyungpook National University, Kyungpook, South Korea.
3Division of Preventive Medicine, Mayo Clinic, USA, Rochester.
4Division of Library Sciences, Mayo Clinic, USA, Rochester.
5Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Western Australia, Australia.
Abstract
Background & aims: Chronic hepatitis B (CHB) can lead to hepatocellular carcinoma (HCC). While both tenofovir disoproxil (TDF) and entecavir (ETV) have been shown to reduce the risk of HCC, their comparative effectiveness is unclear. We estimated the comparative effectiveness of these two agents in reducing the risk of HCC in patients with CHB, through a systematic review and meta-analysis.
Approach & results: We searched multiple electronic databases from Jan 1, 1998 to October 31, 2019, for randomized controlled trials (RCTs) and observational comparative effectiveness studies in adults with CHB treated with ETV compared to TDF, reporting the incidence of HCC (minimum follow-up 12 months). Primary outcome was incidence of HCC, calculated as incidence rate ratio (IRR) with 95% CI (unadjusted analysis) and hazard ratio (HR) with 95% CI (adjusted analysis, where reported). Of 1971 records identified, 14 studies (263,947 person-years) were included for quantitative analysis. On unadjusted meta-analysis of 14 studies, the risk of HCC was not statistically different between ETV and TDF (IRR 1.28; 95% CI, 0.99-1.66). When utilizing available adjusted data (multivariate or propensity-matched data), the risk of HCC among patients treated with ETV was 27% higher when compared to TDF (7 studies; 95% CI, 1.01-1.60, p=0.04). Additional analysis of adjusted data when separately reported among patients with cirrhosis demonstrated an adjusted HR of 0.90 (95% CI, 0.66 - 1.23), suggesting no difference between ETV and TDF-treated groups. The overall confidence in estimates was very low (observational studies, high heterogeneity).
Conclusions: Tenofovir may be associated with lower risk of HCC when compared to entecavir.