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Entecavir versus Lamivudine therapy for patients with chronic hepatitis B-associated liver failure: a meta-analysis.

Zhang X, An Y, Jiang X, Xu M, Xu L, Chen S, Xi Y - Hepat Mon (2014)

Bottom Line: Risk ratio (RR) and mean difference (MD) were used to measure the effects.In addition, no drug related adverse effects were observed in the two treatment groups.It is suggested to perform further studies to verify the results.

View Article: PubMed Central - PubMed

Affiliation: Division of Liver Disease, Jinan Infectious Disease Hospital, Shandong University, Jinan, China.

ABSTRACT

Background: Nucleoside analogues are recommended as antiviral treatments for patients with hepatitis B virus (HBV)-associated liver failure. Clinical data comparing entecavir (ETV) and lamivudine (LAM) are inconsistent in this setting.

Objectives: To compare the efficacy and safety of ETV and LAM in patients with chronic hepatitis B (CHB)-associated liver failure.

Patients and methods: A literature search was performed on articles published until January 2014 on therapy with ETV and LAM for patients with CHB-associated liver failure. Risk ratio (RR) and mean difference (MD) were used to measure the effects. Survival rate was the primary efficacy measure, while total bilirubin (TBIL), prothrombin activity (PTA) changes and HBV DNA negative change rates were secondary efficacy measures. A quantitative meta-analysis was performed to compare the efficacy of the two drugs. Safety of ETV and LAM was observed.

Results: Four randomized controlled trials and nine retrospective cohort studies comprising a total of 1549 patients were selected. Overall analysis revealed comparable survival rates between patients received ETV and those received LAM (4 weeks: RR = 1.03, 95%CI [0.89, 1.18], P = 0.73; 8 weeks: RR = 0.98, 95% CI [0.85, 1.14], P = 0.84; 12 weeks: RR = 0.98, 95% CI [0.90, 1.08], P = 0.70; 24 weeks: RR = 1.02, 95% CI [0.94, 1.10], P = 0.66). After 24 weeks of treatment, patients treated with ETV had a significantly lower TBIL levels (MD = -37.34, 95% CI [-63.57, -11.11], P = 0.005), higher PTA levels (MD = 11.10, 95% CI [2.47, 19.73], P = 0.01) and higher HBV DNA negative rates (RR = 2.76, 95% CI [1.69, 4.51], P < 0.0001) than those treated with LAM. In addition, no drug related adverse effects were observed in the two treatment groups.

Conclusions: ETV and LAM treatments had similar effects to improve 24 weeks survival rate of patients with CHB-associated liver failure, but ETV was associated with greater clinical improvement. Both drugs were tolerated well during the treatment. It is suggested to perform further studies to verify the results.

No MeSH data available.


Related in: MedlinePlus

Funnel Plots for Studies Evaluating Twelve Weeks Survival.
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fig14225: Funnel Plots for Studies Evaluating Twelve Weeks Survival.

Mentions: Funnel plots of studies used in this meta-analysis reporting 12 weeks and 24 weeks survival are shown in figures 9 and 10, respectively (Funnel plots for other survival time-points are not presented). None of the studies lay outside the limits of 95% CI. The trim and fill method analysis obtained the theoretical pooled estimate RR (12 weeks: RR = 0.86, 95% CI [0.68, 1.09], P = 0.20; 24 weeks: RR = 0.88, 95% CI [0.62, 1.24], P = 0.46) after theoretically unreported studies (3 and 3 for 12 and 24 weeks, respectively) were added and the results did not affect the outcome of the meta-analysis. Therefore, no evidence of publication bias was found in our study.


Entecavir versus Lamivudine therapy for patients with chronic hepatitis B-associated liver failure: a meta-analysis.

Zhang X, An Y, Jiang X, Xu M, Xu L, Chen S, Xi Y - Hepat Mon (2014)

Funnel Plots for Studies Evaluating Twelve Weeks Survival.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4286714&req=5

fig14225: Funnel Plots for Studies Evaluating Twelve Weeks Survival.
Mentions: Funnel plots of studies used in this meta-analysis reporting 12 weeks and 24 weeks survival are shown in figures 9 and 10, respectively (Funnel plots for other survival time-points are not presented). None of the studies lay outside the limits of 95% CI. The trim and fill method analysis obtained the theoretical pooled estimate RR (12 weeks: RR = 0.86, 95% CI [0.68, 1.09], P = 0.20; 24 weeks: RR = 0.88, 95% CI [0.62, 1.24], P = 0.46) after theoretically unreported studies (3 and 3 for 12 and 24 weeks, respectively) were added and the results did not affect the outcome of the meta-analysis. Therefore, no evidence of publication bias was found in our study.

Bottom Line: Risk ratio (RR) and mean difference (MD) were used to measure the effects.In addition, no drug related adverse effects were observed in the two treatment groups.It is suggested to perform further studies to verify the results.

View Article: PubMed Central - PubMed

Affiliation: Division of Liver Disease, Jinan Infectious Disease Hospital, Shandong University, Jinan, China.

ABSTRACT

Background: Nucleoside analogues are recommended as antiviral treatments for patients with hepatitis B virus (HBV)-associated liver failure. Clinical data comparing entecavir (ETV) and lamivudine (LAM) are inconsistent in this setting.

Objectives: To compare the efficacy and safety of ETV and LAM in patients with chronic hepatitis B (CHB)-associated liver failure.

Patients and methods: A literature search was performed on articles published until January 2014 on therapy with ETV and LAM for patients with CHB-associated liver failure. Risk ratio (RR) and mean difference (MD) were used to measure the effects. Survival rate was the primary efficacy measure, while total bilirubin (TBIL), prothrombin activity (PTA) changes and HBV DNA negative change rates were secondary efficacy measures. A quantitative meta-analysis was performed to compare the efficacy of the two drugs. Safety of ETV and LAM was observed.

Results: Four randomized controlled trials and nine retrospective cohort studies comprising a total of 1549 patients were selected. Overall analysis revealed comparable survival rates between patients received ETV and those received LAM (4 weeks: RR = 1.03, 95%CI [0.89, 1.18], P = 0.73; 8 weeks: RR = 0.98, 95% CI [0.85, 1.14], P = 0.84; 12 weeks: RR = 0.98, 95% CI [0.90, 1.08], P = 0.70; 24 weeks: RR = 1.02, 95% CI [0.94, 1.10], P = 0.66). After 24 weeks of treatment, patients treated with ETV had a significantly lower TBIL levels (MD = -37.34, 95% CI [-63.57, -11.11], P = 0.005), higher PTA levels (MD = 11.10, 95% CI [2.47, 19.73], P = 0.01) and higher HBV DNA negative rates (RR = 2.76, 95% CI [1.69, 4.51], P < 0.0001) than those treated with LAM. In addition, no drug related adverse effects were observed in the two treatment groups.

Conclusions: ETV and LAM treatments had similar effects to improve 24 weeks survival rate of patients with CHB-associated liver failure, but ETV was associated with greater clinical improvement. Both drugs were tolerated well during the treatment. It is suggested to perform further studies to verify the results.

No MeSH data available.


Related in: MedlinePlus