Research Papers:
Systematic review with network meta-analysis: Comparative efficacy of oral nucleos(t)ide analogues for the prevention of chemotherapy-induced hepatitis B virus reactivation
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Abstract
Min-Yue Zhang1,*, Gui-Qi Zhu2,3,*, Ke-Qing Shi2,4, Ji-Na Zheng2,3, Zhang Cheng2,3, Zhuo-Lin Zou5, Hong-Hui Huang1, Fang-Yuan Chen1, Ming-Hua Zheng2,4
1Department of Hematology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
2Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
3School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China
4Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China
5Department of Infection Diseases, the First Hospital of Jiaxing, Jiaxing 314000, China
*Co-first authors, these author contributed equally to this work
Correspondence to:
Ming-Hua Zheng, e-mail: [email protected]
Fang-Yuan Chen, e-mail: [email protected]
Keywords: hepatitis B virus reactivation, chemotherapy, nucleos(t)ide analogues prophylaxis, network meta-analysis, indirect comparison
Received: February 28, 2016 Accepted: April 02, 2016 Published: April 21, 2016
ABSTRACT
Objectives: Currently, no consensus exists regarding the optimal oral prophylactic regimens for hepatitis B surface antigen seropositive patients undergoing chemotherapy. We aimed to compare the efficacy of oral nucleos(t)ide analogues (NAs), including lamivudine, entecavir, adefovir, telbivudine and tenofovir, for the prevention of chemotherapy-induced hepatitis B virus (HBV) reactivation and its related morbidity and mortality in patients with chronic HBV (CHB) infection.
Results: Fifty-two eligible articles consisting of 3892 participants were included. For HBV reactivation, prophylactic treatment with NAs were all significantly superior to no prophylaxis, with odds ratio (OR) from 0.00 (95% confidence interval [CI] 0.00~0.04) for the most effective intervention (tenofovir) to 0.10 (95% CI 0.06~0.14) for the least effective intervention (lamivudine). For secondary outcomes, prophylaxis with NAs also significantly outperformed observation. The results suggested that entecavir reduced the risk of HBV related hepatitis (predicted probability, 83%), HBV related death (68%) and all causes of hepatitis (97%) most efficaciously. It ranked second in decreasing all causes of death (34%).
Materials and Methods: PubMed, Embase and Cochrane Library database were searched for controlled trials up to March 31, 2015. Primary outcome was the incidence of HBV reactivation. Secondary outcomes included the incidence of HBV-related hepatitis and death, all causes of hepatitis and death. Network meta-analysis combined direct and indirect evidence to estimate ORs for the clinical outcomes. A mean ranking and the probability of optimal therapeutic regime was obtained for each treatment based on clinical outcomes.
Conclusions: Available evidence suggests that prophylatic therapy with tenofovir and entecavir may be the most potent interventions in prevention of HBV reactivation and HBV-related morbidity and mortality for CHB infection patients undergoing chemotherapy.
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