Tenofovir versus Entecavir in Treatment of Chronic Hepatitis B Virus with Severe Acute Exacerbation

Abstract

bTenofovir disoproxil fumarate (TDF) and entecavir (ETV) are effective antivirals recommended as first-line monotherapies for treatment of chronic hepatitis B (CHB) infection. This study aimed to compare the short-term efficacies of TDF and ETV in the treatment of CHB with severe acute exacerbation. From 2008 to 2013, 189 consecutive treatment-naive CHB patients receiving TDF (n ‫؍‬ 41) or ETV (n ‫؍‬ 148) for severe acute exacerbation were enrolled. The primary endpoint was overall mortality or receipt of liver transplantation by week 24. The baseline characteristics were comparable between these two groups. By week 24, 8 (19% [95% confidence interval {CI}, 7% to 32%]) patients in the TDF group and 26 (18% [95% CI, 11 to 24%]) patients in the ETV group died (n ‫؍‬ 30) or received liver transplantation (n ‫؍‬ 4) (P ‫؍‬ 0.749). The two groups of patients developed similar rates of liver-related complications and achieved comparable biochemical and virological responses at week 24. Cox regression analysis showed that baseline viral DNA level (P ‫؍‬ 0.002), hypertension (P ‫؍‬ 0.002), model for end-stage liver disease (MELD) score (P ‫؍‬ 0.01), platelet count (P ‫؍‬ 0.005), early presence (within 4 weeks) of ascites (P ‫؍‬ 0.005), hepatic encephalopathy (P ‫؍‬ 0.002), and hepatorenal syndrome (P < 0.001) were independent factors for mortality or liver transplantation. Among the patients who survived by week 24, there was no difference between the two groups in the percentage of patients who had a serum creatinine increase of >0.5 mg/dl from baseline (6.7% [95% CI, 0% to 16%] versus 2.0% [95% CI, 0% to 4.8%] in the TDF and ETV groups, respectively; P ‫؍‬ 0.231), whereas a significant reduction in the estimated glomerular filtration rate (eGFR) was found in the two groups (P ‫؍‬ 0.001 for both). In conclusion, TDF and ETV produce a similar treatment response and clinical outcome in patients with severe acute exacerbation of CHB. C hronic hepatitis B virus (HBV) infection is a major global health issue, affecting around 370 million people worldwide (1). Patients with chronic hepatitis B (CHB) are at a significantly increased risk for the development of liver failure, cirrhosis, and hepatocellular carcinoma (HCC) (2). In its natural course, up to 30% of CHB patients experience a spontaneous reactivation of hepatitis every year (3). Severe acute exacerbation of CHB characterized by high serum alanine aminotransferase (ALT) level, jaundice, and hepatic decompensation leads to a high mortality rate, ranging from 30 to 70% (4, 5). Most guidelines recommend treatment with oral nucleos(t)ide analogues (NUCs) for CHB patients with severe acute exacerbation as soon as possible (6-8). Liver transplantation is the salvage treatment if medical therapy fails; however, this is neither readily available nor feasible in many parts of the world where HBV is highly endemic (5, 9). Lamivudine (LAM) was the first effective oral HBV replication-suppressive agent and has been widely used in patients with severe acute exacerbation of CHB (4,...

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Clinical features of acute hepatitis E super-infections on chronic hepatitis B

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AASLD guidelines for treatment of chronic hepatitis B

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