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Effects of first-line nucleot(s)ide analogues on lipid profiles in patients with chronic hepatitis B: a network meta-analysis

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Abstract

Introduction

Recent studies have found that lipid levels in patients with chronic hepatitis B (CHB) may change during antiviral therapy.

Objective

To assess the effects of first-line nucleot(s)ide analogues (NAs) on lipid profiles in patients with CHB using network meta-analysis.

Methods

Seven electronic databases (PubMed, Embase, Cochrane Library, and four Chinese databases) were searched for cohort studies on the effect of NA on lipids in patients with CHB up to August 1, 2023. The changes of serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were taken as outcomes. The mean difference (MD) of continuous variables and 95% confidence intervals (CI) were calculated using RevMan 5.4 and Stata 16.0 software, and network meta-analysis was based on a frequentist framework.

Results

A total of 4194 patients were included in the study, including patients with CHB treated with entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF), as well as patients not receiving antiviral therapy [patients with inactive CHB who were not receiving antiviral therapy (referred as inactive CHB patients) and non-HBV-infected patients]. TDF reduced TC levels compared to the non-antiviral group (TDF vs. inactive CHB patients: MD =  − 17.27, 95% CI (− 30.03, − 4.47); TDF vs. non-HBV-infected individuals: MD =  − 17.10, 95% CI (− 20.13, − 14.07)). TC changes in the TAF and ETV groups were not statistically different from the non-antiviral group (TAF vs. inactive CHB patients: MD =  − 2.69, 95% CI (− 14.42, 9.04); TAF vs. non-HBV-infected individuals: MD =  − 2.52, 95% CI (− 8.47, 3.43); ETV vs. inactive CHB patients: MD =  − 4.24, 95% CI (− 17.12, 8.64); ETV vs. non-HBV-infected individuals: MD =  − 4.07, 95% CI (− 9.90, 1.75)). The ranking of the effects for lowering TC is as follows: CHB patients treated with nucleotide analogues [with varying efficacy: TDF (SUCRA = 99.9) > ETV (SUCRA = 59.3) > TAF (SUCRA = 43.6)] > inactive CHB patients (SUCRA = 27.3) > non-HBV-infected individuals (SUCRA = 19.9). As for secondary outcomes, among the three antiviral drugs, TDF had the most significant effect on lowering TG, LDL-C, and HDL-C, but none of the three drugs was statistically different from the non-antiviral group. Subgroup analysis showed that the lipid-lowering effect of TDF was more pronounced in the elderly (≥ 50 years).

Conclusion

TDF was effective in lipid reduction, particularly pronounced in the older population. TAF and ETV had a neutral effect to TC, TG, LDL-C, and HDL-C. Despite a relative increase in lipids observed in patients transitioning from TDF to TAF or ETV, these changes remained within acceptable limits.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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  1. Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Kexin Tong, Mingjing Chen, Danni Wang, Jiayi Peng, Jia Zhang & Wenxiang Huang

  2. Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Haifeng Dai, Jiao Zhou & Yujiao Chang

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WH conceptualized and planned the work described; KT, DW, and JP acquired the data; KT, JZ, and YC analyzed and interpreted the data; KT and MC drafted the manuscript and were responsible for manuscript revisions; and HD and JZ were involved in critical revisions of the manuscript. All authors approved the final version of the manuscript as submitted.

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Tong, K., Chen, M., Wang, D. et al. Effects of first-line nucleot(s)ide analogues on lipid profiles in patients with chronic hepatitis B: a network meta-analysis. Eur J Clin Pharmacol 80, 335–354 (2024). https://doi.org/10.1007/s00228-023-03616-y

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