Effects of Tenofovir vs Entecavir on Risk of Hepatocellular Carcinoma in Patients With Chronic HBV Infection: A Systematic Review and Meta-analysis

Choi, Won‐Mook; Choi, Jonggi; Lim, Young Suk

doi:10.1016/j.cgh.2020.05.008

Cited by 81 publications

(95 citation statements)

References 47 publications

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“…and Dave et al . draw the similar conclusions that TDF may be associated with lower risk of HCC when compared to entecavir [ 56 , 57 ].…”

Section: Introductionsupporting

confidence: 55%

“…These studies concluded either both NAs are just as good, or TDF is better than entecavir in HCC prevention. Amidst all the controversies, two recent meta-analyses by Choi et al and Dave et al draw the similar conclusions that TDF may be associated with lower risk of HCC when compared to entecavir [56,57].…”

Section: Na With Low Genetic Barrier To Resistancementioning

confidence: 77%

“…They showed by propensity score-matched analysis that there was no statistically significant difference between TDF and entecavir treatment on HCC risk, with an HR of 1.02. Thereafter, multiple observational studies and meta-analyses concerning the same clinical question on TDF vs. entecavir on HCC development in CHB patients have been published and continue to show that either TDF was associated with a lower risk of HCC than entecavir treatment, or TDF and entecavir treatment did not have a significant difference on the risk of HCC development (Table 1) [56,57]. One of the largest studies was conducted by the authors and colleagues based on a territory-wide retrospective cohort of 1309 and 28,041 patients treated by TDF and entecavir monotherapy in Hong Kong, respectively [58].…”

Section: Na With Low Genetic Barrier To Resistancementioning

confidence: 99%

“…Summary of baseline characteristics and outcomes of studies comparing entecavir (ETV) and tenofovir disoproxil fumarate (TDF) treatment on risk of HCC development (Modified from Choi et al[57] and Dave et al[56] …”

mentioning

confidence: 99%

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Secondary prevention for hepatocellular carcinoma in patients with chronic hepatitis B: are all the nucleos(t)ide analogues the same?

2020

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Reducing the incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) is the key ultimate goal set in essentially all treatment guidelines. There has been solid evidence supporting the relationship between serum hepatitis B virus (HBV) DNA level and risk of HCC. Antiviral treatment with oral nucleos(t)ide analogues (NAs) leads to sustained viral suppression and hence is often adopted as the secondary prevention for HCC in CHB patients. The first-generation NA, lamivudine, reduced the risk of HCC at 3 years compared to placebo; yet, its high emergence of antiviral resistance has made it no longer recommended in the international guidelines. Recent heated debate is about the two current first-line NAs—entecavir and tenofovir disoproxil fumarate (TDF)—Are they just as good to reduce HCC risk in CHB patients? A handful of cohort studies show two different kinds of observations—TDF is better than entecavir in lowering HCC risk, or these two NAs have led to similarly low risk of HCC. Tenofovir alafenamide (TAF), a modified version of TDF higher rate of ALT normalization, would be another potent nucleotide analogue is the treatment of choice for secondary prevention for HCC.

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“…and Dave et al . draw the similar conclusions that TDF may be associated with lower risk of HCC when compared to entecavir [ 56 , 57 ].…”

Section: Introductionsupporting

confidence: 55%

Section: Na With Low Genetic Barrier To Resistancementioning

confidence: 77%

Section: Na With Low Genetic Barrier To Resistancementioning

confidence: 99%

mentioning

confidence: 99%

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Secondary prevention for hepatocellular carcinoma in patients with chronic hepatitis B: are all the nucleos(t)ide analogues the same?

2020

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“…However, they have failed to show consistent results [15][16][17][18][19][20][21][22] . Of note, a recent meta-analysis including more than 60,000 patients from 15 studies demonstrated that TDF significantly reduced the risk of HCC by 20% 23 . Similarly, the ETV group showed a higher incidence of HCC compared to the TDF group in our crude analysis, approximately from 3 years after initiation of therapy.…”

Section: Discussionmentioning

confidence: 99%

Hepatocellular carcinoma and death and transplantation in chronic hepatitis B treated with entecavir or tenofovir disoproxil fumarate

Chon

Lee

et al. 2020

Sci Rep

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Conflicting results have been reported regarding which of entecavir (ETV) or tenofovir disoproxil fumarate (TDF) is associated with better outcomes. Chronic hepatitis B patients who started ETV or TDF between 2010 and 2015 were analysed. The primary outcomes were hepatocellular carcinoma and death and transplantation. The impact of the treatment on the primary outcomes was analysed using Cox proportional hazards models in the entire and propensity score-matched cohorts. A total of 404 patients (180 and 224 in the ETV and TDF groups, respectively) were analysed. The median duration of follow-up was significantly longer in the ETV group (64.0 vs. 49.1 months; P < 0.001). Virological response (79.4% vs. 68.4%; P = 0.018) and sustained virological suppression (59.7% vs. 45.2%; P = 0.005) were significantly higher in the TDF group. TDF was associated with lower hepatocellular carcinoma [hazard ratio (HR) 0.31, 95% confidence interval (95% CI), 0.12-0.79; P = 0.014]; however, statistical significance was not reached after adjusting sustained virological suppression using propensity score matching (HR 0.36, 95% CI 0.12-1.14; P = 0.08). Death and transplantation was comparable. In conclusion, the impact of TDF on the lower hepatocellular carcinoma was blunted after adjusting sustained virological suppression. Further comparison in a larger number of patients who show sustained virological suppression over a longer period of time is needed.

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Risk of Hepatocellular Carcinoma With Tenofovir vs Entecavir Treatment for Chronic Hepatitis B Virus

Tan

Tay

et al. 2022

JAMA Netw Open

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Effects of Tenofovir vs Entecavir on Risk of Hepatocellular Carcinoma in Patients With Chronic HBV Infection: A Systematic Review and Meta-analysis

Cited by 81 publications

References 47 publications

Secondary prevention for hepatocellular carcinoma in patients with chronic hepatitis B: are all the nucleos(t)ide analogues the same?

Secondary prevention for hepatocellular carcinoma in patients with chronic hepatitis B: are all the nucleos(t)ide analogues the same?

Hepatocellular carcinoma and death and transplantation in chronic hepatitis B treated with entecavir or tenofovir disoproxil fumarate

Risk of Hepatocellular Carcinoma With Tenofovir vs Entecavir Treatment for Chronic Hepatitis B Virus

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