Efficacy of Tenofovir-Based Combination Therapy versus Tenofovir Monotherapy in Chronic Hepatitis B Patients Presenting with Suboptimal Responses to Pretreatment: A Meta-Analysis

Abstract

Background/Aims. It remains unclear whether tenofovir disoproxil fumarate- (TDF-) based combination therapy produces better outcomes than TDF monotherapy in chronic hepatitis B (CHB) patients. The aim of this study was to compare the efficacy of the two regimens by performing a meta-analysis. Methods. A comprehensive literature search was performed on the comparison of TDF-based combination therapy and monotherapy for CHB patients in the PubMed, Embase, Web of Science, and the Cochrane Libraries. Both dichotomous and continuous variables were extracted and pooled outcomes were expressed as risk ratio (RR) or standard mean difference (SMD). Results. Nine eligible studies (1089 subjects in total) were included in our analysis. The proportion of patients with undetectable HBV DNA at 24, 48, and 96 weeks were similar between the two comparable groups (62.5% versus 70.9%, P = 0.086; 78.1% versus 83.7%, P = 0.118; 86.4% versus 87.9%, P = 0.626, resp.). HBV DNA reduction, rates of ALT normalization, hepatitis B e antigen (HBeAg) loss, and HBeAg seroconversion were also similar between the two groups. Conclusions. On the current data, TDF-based combination therapy seemed to be no better than those achieved by monotherapy. Further studies are needed to verify this comparison.

Real-world experience with nucleos (t) ide analogue therapy and patient survival rates in chronic viral hepatitis B Treatment Centers in Asmara, Eritrea: A multicenter retrospective observational cohort study

“…In a related analysis, we noted a signi cant improvement in biochemical parameters in both groups. In most studies, the biochemical response in patients treated with TDF and TDF+LAM is similar (53).…”

Efficacy of 24-week Administration of Tenofovir Disoproxil Fumarate in the Management of Naïve Chronic Hepatitis B

“…Longer treatment was associated with higher HBeAg and HBsAg loss or seroconversion [2]. Therefore, combination therapy with drugs from other classes is suggested although longer-duration studies conducted by Liang et al [13] and Chen et al [15] reported that both TDF monotherapy and TDF-based combination therapy possessed good efficacy.…”

“…Many literatures stated that TDF has good efficacy and safety. However, several adverse events have been reported such as renal toxicity and bone demineralization [6], [7], [15]. Other disadvantages of nucleotide analogs in treating CHB are indefinite duration of treatment, risk of developing resistance, and less HBeAg and HBsAg conversions [9], [15].…”

“…However, several adverse events have been reported such as renal toxicity and bone demineralization [6], [7], [15]. Other disadvantages of nucleotide analogs in treating CHB are indefinite duration of treatment, risk of developing resistance, and less HBeAg and HBsAg conversions [9], [15]. Only one single-centered study was found that has discussed the efficacy and side effects of tenofovir in Indonesia [16,17,18].…”

Is Combination Antiviral Therapy Mandatory for Maintenance Therapy in Fully Suppressed Multidrug-Resistant Hepatitis B Patients?

“…The combination therapy did not increase drug-related adverse events [31], but increased economic burden is another issue among treated patients. Although generic drugs have been released, combination therapy doubles the cost.…”