Hepatocellular carcinoma risk in patients with chronic hepatitis B receiving tenofovir- vs. entecavir-based regimens: Individual patient data meta-analysisopen access
- Authors
- Choi, Won-Mook; Yip, Terry Cheuk-Fung; Wong, Grace Lai-Hung; Kim, W. Ray; Yee, Leland J.; Brooks-Rooney, Craig; Curteis, Tristan; Cant, Harriet; Chen, Chien-Hung; Chen, Chi-Yi; Huang, Yi-Hsiang; Jin, Young-Joo; Jun, Dae Won; Kim, Jin-Wook; Park, Neung Hwa; Peng, Cheng-Yuan; Shin, Hyun Phil; Shin, Jung Woo; Yang, Yao-Hsu; Lim, Young-Suk
- Issue Date
- Mar-2023
- Publisher
- Elsevier B.V.
- Keywords
- Chronic hepatitis B; entecavir; hepatocellular carcinoma; individual patient data; meta-analysis; tenofovir disoproxil fumarate
- Citation
- Journal of Hepatology, v.78, no.3, pp.534 - 542
- Indexed
- SCIE
SCOPUS
- Journal Title
- Journal of Hepatology
- Volume
- 78
- Number
- 3
- Start Page
- 534
- End Page
- 542
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/191627
- DOI
- 10.1016/j.jhep.2022.12.007
- ISSN
- 0168-8278
- Abstract
- Background & Aims: The comparative risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) receiving tenofovir disoproxil fumarate (TDF) vs. entecavir (ETV) remains controversial. In this individual patient data (IPD) meta-analysis, we aimed to compare HCC risk between the two drugs and identify subgroups who may benefit more from one treatment than the other. Methods: Published meta-analyses, electronic databases and congress proceedings were searched to identify eligible studies through January 2021. We compared HCC risk between the two drugs using a multivariable Cox proportional hazards model with anonymised IPD from treatment-naive patients with CHB receiving TDF or ETV for >-1 year. Treatment effect consistency was explored in propensity score matching (PSM), weighting (PSW) and subgroup analyses for age, sex, hepatitis B e-antigen (HBeAg) positivity, cirrhosis and diabetes status. Results: We included 11 studies from Korea, Taiwan and Hong Kong involving 42,939 patients receiving TDF (n = 6,979) or ETV (n = 35,960) monotherapy. Patients receiving TDF had significantly lower HCC risk (adjusted hazard ratio [HR] 0.77; 95% CI 0.61-0.98; p = 0.03). Lower HCC risk with TDF was consistently observed in PSM (HR 0.73; 95% CI 0.59-0.88; p <0.01) and PSW (HR 0.83; 95% CI 0.67-1.03; p = 0.10) analyses and in all subgroups, with statistical significance in the >-50 years of age (HR 0.76; 95% CI 0.58-1.00; p <0.05), male (HR 0.74; 95% CI 0.58-0.96; p = 0.02), HBeAg-positive (HR 0.69; 95% CI 0.49-0.97; p = 0.03) and non-diabetic (HR 0.79; 95% CI 0.63-1.00; p <0.05) subgroups. Conclusion: TDF was associated with significantly lower HCC risk than ETV in patients with CHB, particularly those with HBeAg positivity. Longer follow-up may be needed to better define incidence differences between the treatments in various subgroups.
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