Efficacy of entecavir versus tenofovir in preventing hepatocellular carcinoma in patients with chronic hepatitis B with maintained virologic response

Abstract

Background & Aims: Several studies suggested that efficacy of tenofovir in reducing the risk of the development of hepatocellular carcinoma (HCC) might be better than that of entecavir. It remains unknown whether a change in therapy can further reduce the risk of HCC in patients receiving entecavir therapy and achieved goal of antiviral therapy, a maintained undetectable hepatitis B virus (HBV) DNA level in the serum.Methods: A total of 1336 treatment-naïve chronic HBV mono-infected adult patients, who started entecavir or tenofovir treatment and achieved a maintained virologic response during follow-up were analysed.Results: During a median 4.4 years of follow-up (range, 1.0-7.4 years) after achieving virologic response, 99 patients developed HCC. The 5-year cumulative HCC incidence rate was 7.3% and 6.3% for the entecavir and tenofovir groups, respectively, with similar risk of HCC between the two groups (adjusted HR, 0.82; 95% CI, 0.52-1.29; p = 0.3). The risk of HCC was similar in the propensity score-matched cohort (HR, 1.02; 95% CI, 0.68-1.52; p = 0.94) and inverse probability treatment weighting analysis (HR, 1.11; 95% CI, 0.74-1.66; p = 0.62). In the subgroup analysis, HCC risk was similar between the two drugs in both patients with and without cirrhosis. Discussion: In patients showing maintained virologic response, no difference in the risk of HCC between entecavir and tenofovir was observed. This indicates entecavir might be as effective as tenofovir in the prevention of HCC among those patients and suggest that a change in therapy in anticipation of further reducing the risk of HCC might not be necessary for patients receiving entecavir and showing virologic response.

Lower risk of hepatocellular carcinoma with tenofovir than entecavir treatment in subsets of chronic hepatitis B patients: an updated meta‐analysis

“…2A). In the 21 studies 9–20,22,24–28,45–47 reporting aHR, the pooled aHR was 0.81 (95% CI: 0.72–0.91) with significant heterogeneity ( I 2 = 47%, P = 0.007) as well (Fig. 2b).…”

“…The pooled uHR from the 24 studies 9–29,45–47 was 0.76 (95% CI: 0.67–0.86) having significant heterogeneity ( I 2 = 52%, P < 0.001) (Fig. 2A).…”

Novel Liver Stiffness-Based Nomogram for Predicting Hepatocellular Carcinoma Risk in Patients with Chronic Hepatitis B Virus Infection Initiating Antiviral Therapy

“…Our study included similar proportions of patients who first started AVT with ETV (45.0%) and TDF (55.0%), and the type of AVT was not associated with HCC development in univariate analysis. There is controversy on whether TDF is more advantageous than ETV in reducing HCC risk [ 35 ]; however, recently published studies support that the cumulative HCC risk does not change depending on the type of AVT [ 36 , 37 ]. Moreover, a recent study revealed that ETV also showed a similar risk of HCC development when compared to the newly developed tenofovir alafenamide (TAF), a substitute for TDF based on its proven efficacy and safety.…”

Validation of PH and Varices Risk Scores for Prediction of High-Risk Esophageal Varix and Bleeding in Patients with B-Viral Cirrhosis

“…Abdominal ultrasonography with serum alpha-fetoprotein estimation were also performed every 6 months to detect hepatocellular carcinoma (HCC) for cases in which treatment modalities with a curative intent were considered appropriate [ 23 ]. Antiviral therapy using oral nucleos(t)ide analogues was administered to patients with cirrhosis during the follow-up period, if indicated [ 24 , 25 , 26 , 27 ]. For patients with HEVs, a non-selective β-blocker, such as propranolol or carvedilol, was also administered as a prophylaxis for EV bleeding (EVB) according to physicians’ discretion, if not contraindicated.…”