Meta-analysis sheds light on effectiveness of chronic HBV treatments

By Shreeya Nanda, Senior medwireNews Reporter

A meta-analysis of treatments for chronic hepatitis B virus (HBV) infection suggests that tenofovir disoproxil fumarate (TDF) is the most effective option for patients positive and negative for hepatitis B e antigen (HBeAg), but the latter group may also benefit from entecavir treatment.

The researchers caution, however, that firm conclusions cannot be drawn with regard to HBeAg-negative patients owing to lack of sufficient evidence.

The meta-analysis included 22 studies, comprising a total of 7508 treatment-naïve patients. The team used a Bayesian random effects network model to evaluate the relative efficacy of 12 chronic HBV treatments, either monotherapies or combinations, across six surrogate outcome measures.

In patients with HBeAg-positive disease, TDF had the greatest probability of being ranked highest of all included treatment options with regard to both reduction of HBV DNA and normalisation of serum alanine aminotransferase (ALT) levels, at 0.92 and 0.37, respectively.

Pairwise indirect comparisons showed that patients given TDF had a significantly higher likelihood of attaining undetectable levels of HBV DNA than those given any other treatment. The odds ratios of comparisons with lamivudine, adefovir, entecavir, telbivudine, and PEGylated interferon (PEG) alone and together with lamivudine were 33.0, 21.6, 7.61, 11.66, 62.4 and 10.6, respectively.

For HBeAg-negative patients, the team analysed two disconnected networks, one comprising seven therapy options and the other three. In the larger network, entecavir plus TDF was ranked first with respect to HBV DNA reduction (0.54), followed by entecavir monotherapy, telbivudine, PEG plus lamivudine, PEG plus adefovir, PEG alone and lamivudine. But the treatment options did not differ significantly on pairwise comparisons.

When the smaller network was considered, TDF had the highest probability of being ranked first, above adefovir and placebo, with respect to HBV DNA reduction and histological improvements of the liver, at 0.93 and 0.51, respectively. But for ALT normalisation, TDF ranked second, after adefovir. And pairwise comparisons did not reveal any significant differences between the TDF and adefovir for any outcome.

“With an increasing number of options for treating hepatitis B, more research needs to be conducted”, conclude Lindsay Govan, from the University of Glasgow in the UK, in the European Journal of Gastroenterology & Hepatology.

“Our analysis suggests that further research should be focussed on strengthening connections within the HBeAg-positive network and also connecting the networks in the HBeAg-negative patients by investigating directly whether there are any differences in efficacy between ETV and TDF.”

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