Most Read Articles
12 May 2019
Prediabetes or diabetes does not appear to increase the risk of gastric adenocarcinoma, according to a recent study.
Tristan Manalac, 4 days ago
Left ventricular assist devices (LVADs) can reverse pulmonary hypertension secondary to left heart disease regardless of baseline pulmonary vascular resistance, according to a new study.
11 May 2019
Acute kidney injury (AKI) commonly occurs within a year after cancer diagnosis in paediatric patients and is tied to long-term deteriorations in renal function, a recent study has found.
Jairia Dela Cruz, 4 days ago
Postmenopausal women with hormone receptor (HR)-positive breast cancer fare well with the addition of denosumab to aromatase inhibitors, with data from the phase III ABCSG-18 trial showing that the antiresorptive drug cuts the risk of fractures and confers a modest but significant improvement in disease-free survival with a favourable tolerability profile.

Risk of HCC lower with tenofovir than entecavir in chronic hepatitis B patients

20 Mar 2019
Current guidelines for the treatment of chronic hepatitis B (CHB) recommend entecavir (ETV), tenofovir disoproxil fumarate (TDF), or tenofovir alafenamide (TAF) as first-line oral agents. [Hepatology 2018;67:1560-1599; Hepatol Int 2016;10:1-98; J Hepatol 2017;67:370-398] TAF, like TDF, is a phosphonate prodrug of tenofovir. Whether tenofovir is superior to entecavir in specific clinical settings, or both antivirals have comparable clinical outcomes in real-world cohorts, remains to be extensively studied as these would have considerable implications for practice and the prevention of hepatocellular carcinoma (HCC) in the CHB population.

Tenofovir vs entecavir: Korean data
Treatment with either tenofovir or entecavir has been shown to reduce HCC incidence in patients with CHB. [Hepatology 2017;66:1444-1453; J Viral Hepat 2018;doi:10.1111/jvh.12971] But currently, there appear to be no randomized comparator trials of tenofovir vs entecavir in reducing HCC risk.

In a recent nationwide, population cohort study, researchers compared incidence rates of HCC, death, or liver transplant in patients with CHB listed in the Korean National Health Insurance Service claims database and who started treatment with either tenofovir or entecavir. The primary outcome was development of HCC; the secondary outcomes were all-cause mortality and liver transplant. Findings from the national cohort (24,156 with CHB and 984 with HCC) were validated in a large hospital cohort (2,701 with CHB and 154 with HCC) treated with either agent. [JAMA Oncol 2018;doi:10.1001/jamaoncol.2018.4070]

Tenofovir has advantage in HCC prevention
During follow-up, 590 patients in the entecavir group vs 394 in the tenofovir group developed HCC. The annual incidence rate of HCC was significantly lower with tenofovir (0.64 vs 1.06 per 100 person-years). Treatment with tenofovir was associated with a significantly lower risk of HCC (hazard ratio [HR], 0.61, 95 percent confidence interval [CI], 0.54–0.70; p<0.001) and all-cause mortality or transplant (HR, 0.77, 95 percent CI, 0.65–0.92) vs entecavir in the multivariable adjusted analysis. HCC risk was also significantly lower for tenofovir in the propensity score-matched population cohort (HR, 0.62; p<0.001) and 869-pair propensity score-matched hospital cohort (HR, 0.68) vs entecavir.

“Our data suggest that tenofovir treatment may be associated with a significantly lower risk of HCC in patients with CHB vs entecavir treatment,” said principal investigator Dr Chonggi Choi and colleagues from the Liver Centre, Department of Gastroenterology, Asan Medical Center in Seoul, Korea. “Given the poor prognosis of HCC patients, these findings may have considerable clinical implications in the prevention of HCC in CHB patients.”

Based on these data, 185 HCC cases may have been preventable at 4 years follow-up if the 11,464 patients in the entecavir group had used tenofovir.

Time for guideline update?
Overall, the risk of HCC was consistently about 35 percent lower in those treated with tenofovir than entecavir, wrote Dr Jennifer Flemming from the Queen’s University in Kingston, Ontario, Canada and Dr Norah Terrault from the University of California, San Francisco, in San Francisco, California, US in an editorial. This association persisted even when patients were stratified for cirrhosis status and after adjustment for confounders. “These striking findings raise the question of whether the current CHB guidelines should be updated to reflect this observed superior anticancer benefit of tenofovir over entecavir,” they said. [JAMA Oncol 2019;5:17-18]
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Singapore digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
12 May 2019
Prediabetes or diabetes does not appear to increase the risk of gastric adenocarcinoma, according to a recent study.
Tristan Manalac, 4 days ago
Left ventricular assist devices (LVADs) can reverse pulmonary hypertension secondary to left heart disease regardless of baseline pulmonary vascular resistance, according to a new study.
11 May 2019
Acute kidney injury (AKI) commonly occurs within a year after cancer diagnosis in paediatric patients and is tied to long-term deteriorations in renal function, a recent study has found.
Jairia Dela Cruz, 4 days ago
Postmenopausal women with hormone receptor (HR)-positive breast cancer fare well with the addition of denosumab to aromatase inhibitors, with data from the phase III ABCSG-18 trial showing that the antiresorptive drug cuts the risk of fractures and confers a modest but significant improvement in disease-free survival with a favourable tolerability profile.