Efficacy and safety of antiviral therapy for HBV in different trimesters of pregnancy: systematic review and network meta-analysis

Wu, Yinghui; Liu, Jinfeng; Feng, Yali; Fu, Shan; Ji, Fanpu; Ge, Long; Yao, Naijuan; Luo, Xufei; Zhao, Yingren; Chen, Yaolong; Yang, Yuan; Chen, Tian-yan

doi:10.1007/s12072-020-10026-0

Cited by 16 publications

(20 citation statements)

References 39 publications

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“…Numerous studies have emerged in recent years that favor the use of tenofovir disoproxil fumarate (TDF) because of its high efficacy and safety profile in addition to its high barrier to resistance (Table 4). [6][7][8][9][10][11][12] Patients who become pregnant while already maintained on HBV treatment should be assessed for both the appropriateness of the drug therapy and their response to treatment. Patients should be continued on HBV antiviral therapy (AVT) throughout the pregnancy and after delivery in the long term.…”

Section: Hepatitis B Virusmentioning

confidence: 99%

Viral Hepatitis in Pregnancy: An Update on Screening, Diagnosis, and Management

Sanghi

Lindenmeyer

2021

Clinical Liver Disease

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Viral hepatitis in pregnancy is common; accordingly, there is a need for evolved best practices in the approach to treatment of this special population. 1 Historically, the major limitation to standardization of evaluation and management of pregnant patients with viral hepatitis had been the availability of high-quality evidence and consensus expert opinion. In this article, we review the updated evidence for the screening, diagnosis, and management of acute and chronic viral hepatitis in pregnancy.Viral hepatitis in pregnancy increases the risk for pregnancy-related complications, as well as the risks associated with acute and chronic liver disease for both the mother and the infant as a result of mother-to-child transmission (MTCT) (Table 1). 1 A comprehensive and multidisciplinary approach to the management of viral hepatitis in pregnancy is necessary to reduce morbidity, mortality, and need for liver transplantation. This methodology involves early identification by screening, use of prevention techniques, encouragement of safe breastfeeding, treatment of infection, and immunoprophylaxis (Tables 1 and 2). HePaTiTis a virUsHepatitis A virus (HAV) typically has minimal impact on pregnancy. Testing in acute illness includes serum anti-HAV

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Section: Hepatitis B Virusmentioning

confidence: 99%

Viral Hepatitis in Pregnancy: An Update on Screening, Diagnosis, and Management

Sanghi

Lindenmeyer

2021

Clinical Liver Disease

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“…A Bayesian network meta-analysis and system review showed that the risk of MTCT decreased significantly in pregnant women accepting intervention before 28 weeks of gestation, as compared to those initiating after 28 weeks (relative risk: 0.019, (0.00034-0.19)). 36 Additionally, the efficacy and safety of antiviral therapy initiated from 24 weeks of gestation have been identified in cohort studies and case-control studies. 10 , 11 , 31 , 37 , 38 Therefore, pregnant women with high HBV DNA levels (>2×10 5 IU/mL) are recommended to initiate antiviral intervention at 24-28 weeks of gestation.…”

Section: Recommendationsmentioning

confidence: 99%

2019 Chinese Clinical Practice Guidelines for the Prevention of Mother-to-child Transmission of Hepatitis B Virus

Liu¹,

Chen²,

Chen³

et al. 2020

Journal of Clinical and Translational Hepatology

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To develop the evidence-based guidelines for managing mother-to-child transmission of hepatitis B virus in China, a multidisciplinary guideline development group was established. Clinical questions were identified from two rounds of surveys on the concerns of first-line clinicians. We conducted a comprehensive search and review of the literature. A grading of recommendations' assessment, development, and evaluation system was adopted to rate the quality of evidence and the strength of recommendations. Recommendations were formulated based on the evidence, overall balance of benefits and harms (at individual and population levels), patient/health worker values and preferences, resources available, cost-effectiveness, and feasibility. Eventually, recommendations related to 13 main clinical concerns were developed, covering diagnostic criteria, treatment indications, antiviral therapy choice, timing to initiate and discontinue treatment, immunoprophylaxis strategy at birth, and how to deal with special situations, such as unintended pregnancy, assisted reproduction, and breastfeeding. The guidelines are intended to serve as guidance for clinicians and patients, to optimize the management of majority of pregnant women who are positive for hepatitis B surface antigen. Guideline registration: International Practice Guide Registration Platform (IPGRP-2018CN040).

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“…Systematic review and meta-analysis report lamivudine, telbivudine and tenofovir disoproxil fumarate (tenofovir) provided in the third trimester can interrupt MTCT of HBV in hepatitis B e antigen (HBeAg) positive women with high HBV DNA > 10 6 IU/mL [13]. Recent meta-analysis suggests better prevention of MTCT with telbivudine and tenofovir, and by initiation of antivirals before the third trimester [13]. However the reduction of HBV DNA is highly dependent on starting viraemia and weeks of treatment with tenofovir.…”

Section: Introductionmentioning

confidence: 99%

“…There is evidence from HIV that antivirals are safe and effective in prevention of MTCT in RLS in Africa and Asia [ 9 – 12 ]. Systematic review and meta-analysis report lamivudine, telbivudine and tenofovir disoproxil fumarate (tenofovir) provided in the third trimester can interrupt MTCT of HBV in hepatitis B e antigen (HBeAg) positive women with high HBV DNA > 10 6 IU/mL [ 13 ]. Recent meta-analysis suggests better prevention of MTCT with telbivudine and tenofovir, and by initiation of antivirals before the third trimester [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Tenofovir for prevention of mother to child transmission of hepatitis B in migrant women in a resource-limited setting on the Thailand-Myanmar border: a commentary on challenges of implementation

Bierhoff

Rijken

Yotyingaphiram

et al. 2020

Int J Equity Health

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Background The aim of this manuscript is to highlight challenges in the implementation of maternal tenofovir disoproxil fumarate (tenofovir) for prevention of mother to child transmission (PMTCT) of hepatitis B virus (HBV) in resource limited setting. Current preventive strategies in resource-limited settings fail mainly due to prohibitive costs of hepatitis B immunoglobulin (HBIG) and a high proportion of homebirths, meaning both HBIG and hepatitis B birth dose vaccine are not given. A new strategy for PMTCT without the necessity of HBIG, could be daily tenofovir commenced early in gestation. Implementation challenges to early tenofovir for PMTCT can provide insight to elimination strategies of HBV as the burden of disease is high in resource-limited settings. Methods Challenges encountered during implementation of a study of tenofovir for PMTCT before 20 weeks gestation in rural and resource-limited areas on the Thailand-Myanmar border were identified informally from trial study logbooks and formally from comments from patients and staff at monthly visits. ClinicalTrials.gov Identifier: NCT02995005. Main body During implementation 171 pregnant women were hepatitis B surface antigen (HBsAg) positive by point of-care test over 19 months (May-2018 until Dec-2019). In this resource-limited setting where historically no clinic has provided tenofovir for PMTCT of HBV, information provided by staff resulted in a high uptake of study screening (95.5% (84/88) when offered to pregnant women. False positive point-of-care rapid tests hinder a test and treat policy for HBV and development of improved rapid tests that include HBeAg and/or HBV DNA would increase efficiency. Integrated care of HBV to antenatal care, transport assistance and local agreements to facilitate access, could increase healthcare at this critical stage of the life course. As safe storage of medication in households in resource-limited setting may not be ideal, interactive counseling about this must be a routine part of care. Conclusion Despite challenges, results from the study to date suggest tenofovir can be offered to HBV-infected women in resource-limited settings before 20 weeks gestation with a high uptake of screening, high drug accountability and follow-up, with provision of transportation support. This commentary has highlighted practical implementation issues with suggestions for strategies that support the objective of PMTCT and the World Health Organization goal of HBV elimination by 2030.

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Efficacy and safety of antiviral therapy for HBV in different trimesters of pregnancy: systematic review and network meta-analysis

Cited by 16 publications

References 39 publications

Viral Hepatitis in Pregnancy: An Update on Screening, Diagnosis, and Management

Viral Hepatitis in Pregnancy: An Update on Screening, Diagnosis, and Management

2019 Chinese Clinical Practice Guidelines for the Prevention of Mother-to-child Transmission of Hepatitis B Virus

Tenofovir for prevention of mother to child transmission of hepatitis B in migrant women in a resource-limited setting on the Thailand-Myanmar border: a commentary on challenges of implementation

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