Switching to Tenofovir Therapy Versus Continuation of Entecavir for Patients With Hepatitis B Virus Infection: A Systematic Review and Meta-Analysis

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY JGH Open Pub Date : 2024-11-24 DOI:10.1002/jgh3.70055
Muhammad Shahzil, Ammad Javaid Chaudhary, Talha Kashif, Ali Akram Qureshi, Anza Muhammad, Faiza Khan, Muhammad Saad Faisal, Muhammad Ali Khaqan, Hassam Ali, Yara Dababneh, Dilip Moonka
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Abstract

Background

Hepatitis B virus (HBV) infection causes liver disease, including hepatocellular carcinoma. Controlling viral activity is crucial to reducing complications. Tenofovir may offer benefits over entecavir, but it is unclear if switching from entecavir to tenofovir improves outcomes. This study assesses the clinical impact of switching to tenofovir therapy for chronic HBV infection.

Methods

Following the PRISMA guidelines, we conducted a literature search within the Cochrane Library, PubMed, MEDLINE, Embase, and Scopus for studies of patients with HBV infection who were switched to tenofovir from entecavir or were maintained on entecavir. Both formulations of tenofovir, that is, tenofovir disoproxil fumarate and tenofovir alafenamide were included and analyzed in subgroup analysis. Meta-analyses were performed with RevMan 5.4 using a random-effects model, with statistical significance set at p < 0.05.

Results

A total of eight studies, comprising 833 patients, were included in the meta-analysis. Tenofovir showed a significantly higher likelihood of achieving complete virological response (RR 5.60; 95% CI 3.51–8.94; p < 0.00001) and a greater reduction in HBV DNA levels (MD −1.03 log IU/mL; 95% CI −1.69 to −0.36; p = 0.002) compared to entecavir. However, there was no significant difference in HBsAg reduction or HBeAg seroconversion between the two groups. ALT reductions were not statistically significant overall, although entecavir showed better outcomes in subgroup analysis.

Conclusion

Switching from entecavir to tenofovir improves virological response and reduces HBV DNA levels, but shows no significant advantage in HBsAg reduction, HBeAg seroconversion, or overall, ALT reduction.

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乙型肝炎病毒感染者转用替诺福韦治疗与继续使用恩替卡韦治疗的比较:系统回顾与元分析
背景 乙型肝炎病毒(HBV)感染会导致肝病,包括肝细胞癌。控制病毒活性对减少并发症至关重要。与恩替卡韦相比,替诺福韦可能更具优势,但从恩替卡韦转为替诺福韦是否能改善疗效尚不清楚。本研究评估了改用替诺福韦治疗慢性 HBV 感染的临床影响。 方法 按照 PRISMA 指南,我们在 Cochrane 图书馆、PubMed、MEDLINE、Embase 和 Scopus 中检索了有关 HBV 感染患者从恩替卡韦转为替诺福韦或继续使用恩替卡韦的研究文献。研究纳入了两种替诺福韦制剂,即富马酸替诺福韦二吡呋酯和替诺福韦阿拉非那胺,并对其进行了亚组分析。元分析使用 RevMan 5.4 进行,采用随机效应模型,统计显著性设定为 p < 0.05。 结果 共有 8 项研究纳入了荟萃分析,其中包括 833 名患者。与恩替卡韦相比,替诺福韦获得完全病毒学应答的可能性明显更高(RR 5.60; 95% CI 3.51-8.94; p <0.00001),HBV DNA水平的降低幅度也更大(MD -1.03 log IU/mL; 95% CI -1.69 to -0.36; p = 0.002)。然而,两组之间在 HBsAg 降低或 HBeAg 血清转换方面没有明显差异。尽管在亚组分析中恩替卡韦显示出更好的疗效,但ALT的降低总体上没有统计学意义。 结论 从恩替卡韦转为替诺福韦可改善病毒学应答并降低 HBV DNA 水平,但在 HBsAg 降低、HBeAg 血清转换或 ALT 整体降低方面并无显著优势。
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来源期刊
JGH Open
JGH Open GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
3.40
自引率
0.00%
发文量
143
审稿时长
7 weeks
期刊最新文献
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