Comparative efficacy of tenofovir and entecavir in nucleos(t)ide analogue-naive chronic hepatitis B: A systematic review and meta-analysis

Abstract

ObjectiveTo compare the efficacy of tenofovir and entecavir in nucleos(t)ide analogue-naive chronic hepatitis B.MethodsThe Web of Science, PubMed, Cochrane Library, EMBASE, Clinical Trials and China National Knowledge Infrastructure(CNKI) databases were electronically searched to collect randomized controlled trials (RCTs) regarding the comparison between tenofovir and entecavir in nucleos(t)ide analogue-naive chronic hepatitis B (CHB) since the date of database inception to July 2019. Two researchers independently screened and evaluated the obtained studies and extracted the outcome indexes. RevMan 5.3 software was used for the meta-analysis.ResultsEarly on, tenofovir had a greater ability to inhibit the hepatitis B virus, I2 = 0% [RR = 1.08, 95% CI (1.03, 1.13), P<0.01] (96 weeks). Entecavir can normalize the ALT levels earlier, I2 = 0% [RR = 0.87, 95% CI (0.77, 0.98), P = 0.02] (48 weeks). However, there was no statistically significant difference between TDF and ETV at 144 weeks. Tenofovir was as effective as entecavir in terms of HBeAg clearance and HBeAg seroconversion, I2 = 0% [RR = 1.05, 95% CI (0.68, 1.62), P = 0.82]; I2 = 69% [RR = 0.93, 95% CI (0.54, 1.61), P = 0.80]. The difference in the incidence of elevated creatine kinase levels was not statistically significant I2 = 0% [RR = 0.66, 95% CI (0.27, 1.60), P = 0.35].ConclusionsTenofovir and entecavir were equally effective in the treatment of patients with nucleos(t)ide analogue-naive chronic hepatitis B. In addition, TDF has an advantage in the incidence of hepatocellular carcinoma. Additional RCTs and a large-sample prospective cohort study should be performed.

Tenofovir Treatment Has Lower Risk of Hepatocellular Carcinoma than Entecavir Treatment in Patients with Chronic Hepatitis B: A Systematic Review and Meta-Analysis

“…Previous meta-analyses have evaluated differential HCC incidence with ETV and TDF treatment [21][22][23][24]. Although their findings were broadly consistent with our findings, a strength of our study is the inclusion of the large cohort study that has recently been published [9].…”

Comparison of 48‐week efficacy of tenofovir vs entecavir for patients with chronic hepatitis B: A network meta‐analysis

“…It remains to be seen however whether the higher rate of virological response at 48 weeks in TDF can be attributed to a difference in the early viral kinetics with NA treatment. There are few studies in this area; Suh et al 31 While our findings support those from a previous meta-analysis by Chen et al, 9 their study also suggested that HBV DNA suppression was no different at 144 weeks. However, their analysis included only two studies at this time point.…”

“…8 We searched each database for studies published from 1 January 2000 to 4 February 2020. All records from the search as well as additional studies included in five recent meta-analyses [9][10][11][12][13] found were also included to be screened. Records were screened using a combination of title and abstract.…”

Comparison of tenofovir versus entecavir on reducing incidence of hepatocellular carcinoma in chronic hepatitis B patients: A systematic review and meta‐analysis

“…A better virological suppression response means a higher immune response, which could also damage liver cells. This also explains why TDF is less protective of liver function than ETV 45 . Second, our main findings may only be observed in patients treated with nucleotide analogues (adefovir dipivoxil and TDF), but not in those treated with nucleoside analogues (lamivudine and ETV) 46 .…”