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Lower risk of hepatocellular carcinoma with tenofovir than entecavir in antiviral treatment-naïve chronic hepatitis B patients: a systematic review and meta-analysis involving 90,897 participants

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Abstract

Entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are equally recommended as first-line treatments for antiviral treatment-naïve (ART-naïve) chronic hepatitis B (CHB) patients by practice guidelines because of their similarly high antiviral efficacy and low resistance rate. However, whether one is superior to the other in terms of hepatocellular carcinoma (HCC) prevention is currently largely controversial. We aimed to identify and synthesize these existing studies regarding the HCC risk of these two highly potent antivirals in treatment-naïve CHB patients. PubMed, EMBASE, and Cochrane Library were searched for studies between January 1, 2012 and June 25, 2022. These studies used ETV monotherapy and/or TDF monotherapy to treat ART-naïve CHB patients and reported the incidence of HCC. The extracted data were analyzed using a DerSimonian–Laird random-effects models. The HCC incidence difference was expressed as hazard ratio (HR) and 95% confidence interval (95% CI). A total of 17 studies with 90,897 ART-naïve CHB patients (ETV = 60,980 vs TDF = 29,917) were included in this meta-analysis. Compared with ETV, TDF was associated with a significant lower cumulative incidence of HCC (HR 0.66; 95% CI 0.56–0.76). No significant heterogeneity or publication bias was found among the included studies (I2 = 48.1%, Begg’s p = 0.363 and Egger’s p = 0.748). TDF is associated with a lower risk of HCC compared with entecavir in ART-naïve CHB patients. The results suggest that TDF may be a better option for ART-naïve CHB patients with high HCC risks.

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Funding

This work was supported by Beijing Hospitals Authority focal medical development plan (ZYLX202138).

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  1. Jinman Shao and Yishu Wang have contributed equally as first authors.

Authors and Affiliations

  1. Comprehensive Internal Medicine Department, Beijing Xiaotangshan Hospital, Xiaotangshan Town, Changping District, Beijing, 102211, China

    Jinman Shao, Yishu Wang, Ling Hu, Lianchao Zhang & Chunmei Lyu

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  1. Jinman Shao
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  3. Ling Hu
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Contributions

CL and JS provided idea. JS, YW and LH performed data extraction and searches. LZ and JS analyzed the data. CL and JS wrote the paper.

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Correspondence to Chunmei Lyu.

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Shao, J., Wang, Y., Hu, L. et al. Lower risk of hepatocellular carcinoma with tenofovir than entecavir in antiviral treatment-naïve chronic hepatitis B patients: a systematic review and meta-analysis involving 90,897 participants. Clin Exp Med 23, 2131–2140 (2023). https://doi.org/10.1007/s10238-023-00990-w

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