Long-term risk of primary liver cancers in entecavir versus tenofovir treatment for chronic hepatitis B

Abstract

It remains controversial whether entecavir (ETV) and tenofovir disoproxil fumarate (TDF) is associated with different clinical outcomes for chronic hepatitis B (CHB). This study aimed to compare the long-term risk of ETV versus TDF on hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) in CHB patients from a large multi-institutional database in Taiwan. From 2011 to 2018, a total of 21,222 CHB patients receiving ETV or TDF were screened for eligibility. Patients with coinfection, preexisting cancer and less than 6 months of follow-up were excluded. Finally, 7248 patients (5348 and 1900 in the ETV and TDF groups, respectively) were linked to the National Cancer Registry database for the development of HCC or ICC. Propensity score matching (PSM) (2:1) analysis was used to adjust for baseline differences. The HCC incidence between two groups was not different in the entire population (hazard ratio [HR] 0.82; 95% confidence interval [CI] 0.66–1.02, p = 0.078) and in the PSM population (HR 0.83; 95% CI 0.65–1.06, p = 0.129). Among decompensated cirrhotic patients, a lower risk of HCC was observed in TDF group than in ETV group (HR 0.54; 95% CI 0.30–0.98, p = 0.043, PSM model). There were no differences between ETV and TDF groups in the ICC incidence (HR 1.84; 95% CI 0.54–6.29, p = 0.330 in the entire population and HR 1.04; 95% CI 0.31–3.52, p = 0.954 in the PSM population, respectively). In conclusion, treatment with ETV and TDF showed a comparable long-term risk of HCC and ICC in CHB patients.

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

“…A random effects model yielded an uHR of 0.83 (95% CI: 0.71-0.97; I 2 = 52%, P = 0.009; Fig. 3a) in 14 studies including PSM cohorts 9,10,12,[14][15][16][17][18]22,23,26,28,46,47 and aHR of 0.78 (95% CI: 0.58-1.04; I 2 = 48%, P = 0.06) in 8 such studies (Fig. 3B).…”

Entecavir versus tenofovir in patients with chronic hepatitis B: Enemies or partners in the prevention of hepatocellular carcinoma

“…A multicenter retrospective cohort study from Taiwan analyzed 7,248 patients. The HCC incidence rates of ETV and TDF groups were statistical similar in the whole cohort (aHR, 0.82; 95% CIs, 0.66–1.02; P =0.078) and in the PSM cohort (aHR, 0.83; 95% CIs, 0.65–1.06; P =0.129) [ 13 ].…”

Clinical efficacy of antiviral therapy in patients with hepatitis B-related cirrhosis after transjugular intrahepatic portosystemic shunt

“…Based on the above studies, the clinical data of patients with hepatitis B cirrhosis after TIPS treated with different antiviral drugs were retrospectively analyzed in this study. Before this study, many studies[ 23 - 27 ] in the past 2 years have explored the effects of different antiviral drugs on the long-term occurrence of HCC in patients with CHB, most of which are retrospective cohort studies, and some were systematic reviews and meta-analyses, with non-unified conclusions. However, it can be concluded that nucleotide drugs (represented by TFV) are equal or superior to nucleoside analogues (represented by ETV) in the long-term risk of HCC, especially in some patients with high-risk factors for HCC, such as compensated cirrhosis or decompensated cirrhosis.…”