Entecavir slightly better than lamivudine for patients with HBV-related AE, ACLF
Entecavir and lamivudine demonstrate comparable effects on the mortality rate of patients with chronic hepatitis B virus (HBV)-related acute exacerbation with or without acute-on-chronic liver failure (ACLF), reports a study. In patients with ACLF, however, entecavir delivers a more favourable long-term outcome and is associated with greater clinical improvements.
Researchers performed a comprehensive literature search of studies on therapy involving entecavir or lamivudine for chronic HBV-related acute exacerbation with or without ACLF published before December 2015.
Short- (within 4 months) and long-term (beyond 4 months) mortality were the main outcomes. The secondary outcomes were virological and biochemical responses, ACLF recurrence, and safety.
Three prospective and eight retrospective cohort studies met the inclusion criteria, involving a total of 1,491 patients. Overall, short- (risk ratio [RR], 0.99; 95 percent CI, 0.78 to 1.27) and long-term mortality rates (RR, 0.82; 0.45 to 1.52) were similar among all patients who received entecavir or lamivudine.
On the other hand, long-term outcome was more favourable in patients with ACLF who received entecavir vs lamivudine (RR, 0.60; 0.45 to 0.80). In addition, entecavir yielded more efficient virological and biochemical responses than did lamivudine with respect to the HBV DNA undetectable rate (RR, 1.34; 1.09 to 1.63), HBV DNA reduction rate (weighted mean difference, ‒0.41; ‒0.69 to ‒0.13) and serum alanine aminotransferase normalization rate (RR, 1.13; 1.05 to 1.21).
Additional larger, long-term randomized controlled trials are warranted to confirm these findings, according to researchers.
Oral nucleos(t)ide analogues are commonly given in patients with chronic HBV-related acute exacerbation and ACLF, researchers said. This study provided evidence to the safety and efficacy of entecavir and lamivudine to such patients.