Cao Lu, Li Li, Yang Lixing, Zhou Nan, Zhang Yu
Department of Pharmacy, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
Hepatobiliary Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
Front Pharmacol. 2025 Jan 20;16:1507117. doi: 10.3389/fphar.2025.1507117. eCollection 2025.
To systematically evaluate the efficacy and safety of tenofovir and entecavir in chronic hepatitis B-related cirrhosis.
A comprehensive search was conducted in databases including PubMed, Web of Science, Embase and Cochrane Library from the inception until June 2024. Studies on the use of tenofovir and entecavir for chronic hepatitis B-related cirrhosis were collected.
A total of 14 studies involving 14,208 patients were included. The meta-analysis revealed that tenofovir significantly reduced the cumulative incidence of hepatocellular carcinoma and cumulative mortality compared to entecavir in East Asian popupation, while in non East Asian populations, the two groups are roughly equivalent. After 48 weeks, the hepatitis B virus-deoxyribonucleic acid clearance rate in the tenofovir group were comparable to the entecavir group. Both tenofovir and entecavir showed similar effect in reducing the incidence of hepatic encephalopathy. Compared with the entecavir group, patients in the tenofovir group, including tenofovir disoproxil fumarate and tenofovir alafenamide fumarate showed a significant increase in estimated glomerular filtration rate after 48 weeks of treatment.
Compared to entecavir, tenofovir significantly reduced the cumulative incidence of hepatocellular carcinoma and cumulative mortality in chronic hepatitis B-related cirrhosis in East Asian population. However, both drugs were comparable in terms of hepatitis B virus-deoxyribonucleic acid clearance and hepatic encephalopathy. Tenofovir did not significantly cause renal dysfunction, but instead improved estimated glomerular filtration rate levels compared with entecavir. Randomized controlled trials with larger sample size are still needed for validation.
https://www.crd.york.ac.uk/prospero/, identifier CRD42024588432.
系统评价替诺福韦和恩替卡韦治疗慢性乙型肝炎相关肝硬化的疗效和安全性。
从数据库创建至2024年6月，在PubMed、Web of Science、Embase和Cochrane图书馆等数据库中进行全面检索。收集有关替诺福韦和恩替卡韦用于慢性乙型肝炎相关肝硬化的研究。
共纳入14项研究，涉及14208例患者。荟萃分析显示，在东亚人群中，与恩替卡韦相比，替诺福韦显著降低了肝细胞癌的累积发病率和累积死亡率，而在非东亚人群中，两组大致相当。48周后，替诺福韦组的乙肝病毒脱氧核糖核酸清除率与恩替卡韦组相当。替诺福韦和恩替卡韦在降低肝性脑病发病率方面显示出相似的效果。与恩替卡韦组相比，替诺福韦组（包括富马酸替诺福韦二吡呋酯和富马酸丙酚替诺福韦）的患者在治疗48周后估计肾小球滤过率显著增加。
与恩替卡韦相比，替诺福韦显著降低了东亚人群慢性乙型肝炎相关肝硬化中肝细胞癌的累积发病率和累积死亡率。然而，两种药物在乙肝病毒脱氧核糖核酸清除率和肝性脑病方面相当。替诺福韦不会显著导致肾功能障碍，与恩替卡韦相比，反而提高了估计肾小球滤过率水平。仍需要更大样本量的随机对照试验进行验证。
