Comparison of entecavir and lamivudine in preventing HBV reactivation in lymphoma patients undergoing chemotherapy: a meta-analysis

Abstract

Background Multiple studies have compared the efficacy of entecavir with lamivudine in preventing hepatitis B virus (HBV) reactivation among HBV-carrying lymphoma patients with chemotherapy treatment. However, the results were slightly varied. Aim of the review to combine the findings of independent studies assessing the clinical efficacy of the two drugs using a systematic review and meta-analysis. Methods PubMed, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chongqing VIP and WanFang Data were retrieved. Two independent reviewers evaluated the study eligibility and extracted eight studies, with 770 patients in total. The meta-analysis was conducted using RevMan 5.3 and STATA software. Results HBV-carrying lymphoma patients receiving lamivudine during chemotherapy had a statistically significantly higher odds of HBV reactivation compared to those receiving entecavir (OR 5.0, 95 % CI 2.85-8.78, P < 0.001). The odds of hepatitis, HBV-Reactivation caused hepatitis and chemotherapy disruption was statistically significantly elevated in the patient group receiving lamivudine compared to the entecavir group (OR 4.12, 95 % CI 1.70-9.98, P = 0.002; OR 11.44, 95 % CI 2.70-48.52, P < 0.001; OR 6.71, 95 % CI 2.34-19.26, P < 0.001, respectively). Furthermore, the HBV reactivation rate in Ann Arbor stages I - II patient group was statistically significantly lower than the one in Ann Arbor stages III-IV group, with an overall pooled value of 0.37 (95 % CI 0.17-0.82, P = 0.01). Conclusion The metaanalysis result suggested that among HBV-carrying lymphoma patients undergoing chemotherapy, entecavir is more effective than lamivudine in preventing HBV reactivation.

Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance

“…Regardless of baseline serum HBV‐DNA level, prophylactic antiviral therapy should be administered to patients with CHB before (i.e., most often in the literature, antivirals were given 7 days before) the onset of anticancer therapy or a finite course of immunosuppressive therapy . Because of their higher potency and high resistance barrier, prophylactic first‐line NAs (e.g., entecavir or tenofovir) should be preferred over other NAs, given that multiple meta‐analyses have demonstrated reduced reactivation, hepatitis, mortality, and anticancer therapy interruption . When monitoring at‐risk patients without prophylaxis, the preferred antivirals for on‐demand treatment remain first‐line preferred NAs, although the evidence base is far weaker .…”

“…(205) Because of their higher potency and high resistance barrier, prophylactic first-line NAs (e.g., entecavir or tenofovir) should be preferred over other NAs, given that multiple meta-analyses have demonstrated reduced reactivation, hepatitis, mortality, and anticancer therapy interruption. (192,(205)(206)(207) When monitoring at-risk patients without prophylaxis, the preferred antivirals for on-demand treatment remain first-line preferred NAs, although the evidence base is far weaker. (192) The most commonly studied and recommended duration of prophylactic antiviral therapy is 6-12 months (205) after discontinuation of anticancer therapy or immunosuppression.…”

Scoring system for risk stratification of viral reactivation during prophylactic antiviral treatment in Korean patients with hepatitis B undergoing anticancer chemotherapy: A multicenter study

“…Only one of these studies was a randomized trial, and the remaining retrospective studies were limited in the size of study population. Most studies compared entecavir (ETV) and LAM and only a few studies investigated other antiviral agents (eg, telbivudine [LdT] or tenofovir) . In the current study, we aimed to develop an individualized approach toward antiviral prophylaxis through a comparative effectiveness analysis of three different NAs in patients with hematologic malignancies and solid tumors.…”

Tenofovir alafenamide associated fatal lactic acidosis in an autologous hematopoietic stem cell transplant recipient

“…HIV test 18 This recommendation was based on multiple meta-analyses. [19][20][21][22] Of note that these meta-analyses were done on patients receiving chemotherapy in general and not specific to hematopoietic stem cell transplant. Our patient fulfilled the definition of resolved HBV infection with insufficient immunity given low titers of anti-HBs antibodies and was started on TAF prior to transplant upon concern of reactivation of HBV infection.…”