Risk of Hepatocellular Carcinoma in Patients Treated With Entecavir vs Tenofovir for Chronic Hepatitis B

Abstract

IMPORTANCE Entecavir and tenofovir disoproxil fumarate have comparable efficacy in achieving surrogate end points, including virologic response, and are equally recommended as first-line treatments for patients with chronic hepatitis B (CHB). However, it is unclear whether treatment with these drugs is associated with equivalent clinical outcomes, especially development of hepatocellular carcinoma (HCC).OBJECTIVE To compare entecavir and tenofovir in terms of the risk of HCC and death or liver transplant in patients with CHB infection. DESIGN, SETTING, AND PARTICIPANTSA nationwide historical population cohort study involving treatment-naive adult patients with CHB who started treatment with entecavir (n = 11 464) or tenofovir disoproxil fumarate (n = 12 692) between

Tenofovir disoproxil fumarate reduces hepatocellular carcinoma, decompensation and death in chronic hepatitis B patients with cirrhosis

“…14 Recently, a large nationwide Korean cohort study compared the incidence of HCC in CHB patients treated with entecavir vs TDF and found that the TDF group had a significantly lower risk of HCC (hazard ratio [HR] 0.61). 15 Caucasian CHB patients with cirrhosis who did not develop HCC also had similar 8-year survival compared to the general population. 16 However, almost all previous studies of TDF-treated patients did not have direct comparisons to CHB patients unexposed to anti-viral therapies or they had only small numbers of patients with cirrhosis.…”

“…HCC rates in TDF‐treated patients were also lower after 5 years of treatment as compared to the first 5 years . Recently, a large nationwide Korean cohort study compared the incidence of HCC in CHB patients treated with entecavir vs TDF and found that the TDF group had a significantly lower risk of HCC (hazard ratio [HR] 0.61) . Caucasian CHB patients with cirrhosis who did not develop HCC also had similar 8‐year survival compared to the general population …”

“…16 However, almost all previous studies of TDF-treated patients did not have direct comparisons to CHB patients unexposed to anti-viral therapies or they had only small numbers of patients with cirrhosis. [13][14][15][16][17] In the current setting, it would be unethical to perform a placebo-controlled trial to evaluate the efficacy of TDF on reducing hepatic events and death in CHB patients. Furthermore, no large studies have specifically studied the effect of TDF treatment on hepatic decompensation in CHB patients with cirrhosis.…”

Letter: clinical outcomes after long‐term entecavir or tenofovir treatment in patients with hepatitis D and advanced fibrosis

“…However, tenofovir and entecavir may differ in their effectiveness in the prevention of HCC for patients with chronic HBV infection. 4,5 Recently, tenofovir treatment was reported to be associated with a significantly lower risk of HCC compared with entecavir treatment for patients with chronic HBV infection. 4,5 Moreover, the authors evaluated the factors associated with development of HCC in the univariate and multivariate analysis as presented in Table 3.…”

“…4,5 Recently, tenofovir treatment was reported to be associated with a significantly lower risk of HCC compared with entecavir treatment for patients with chronic HBV infection. 4,5 Moreover, the authors evaluated the factors associated with development of HCC in the univariate and multivariate analysis as presented in Table 3. 1 However, family history of HCC, an important HCC risk factor, was not taken into consideration.…”