Reuters Health Information (2010-07-12): Antivirals ranked for effectiveness against chronic hepatitis B
Antivirals ranked for effectiveness against chronic hepatitis B
Last Updated: 2010-07-12 14:00:10 -0400 (Reuters Health)
NEW YORK (Reuters Health) - For the first year of treatment for chronic hepatitis B, tenofovir and entecavir are the most effective agents available, according to the results of a systematic review and meta-analysis.
Writing in Gastroenterology online June 20, Dr. Murray Krahn with the University of Toronto, Ontario, and colleagues explain that as the initial therapy of chronic hepatitis B increases in potency, it becomes less likely that cross-drug resistance will develop with long-term therapy.
The researchers therefore reviewed all published randomized controlled trials (RCTs) of monotherapy or combination therapy for chronic hepatitis B, to estimate the relative efficacies of the treatments and to rank them according to success rates for each outcome.
The analysis included 20 trials in treatment-naive individuals who received lamivudine, pegylated interferon, adefovir, entecavir, telbivudine, and tenofovir, alone or in combination.
For HBeAg-positive patients, undetectable viral DNA levels were most likely with tenofovir monotherapy (predicted probability = 88%) or entecavir (61%). On the other hand, entecavir was more likely than tenofovir to improve liver histology (56% vs. 53%).
In HbeAg-negative patients, tenofovir patients had the highest rates both of undetectable HBV DNA (94%) and histologic improvement (65%).
The authors report that the greatest number of adverse events occurred in patients taking interferon.
Dr. Krahn and associates note that traditional meta-analytic techniques compare only two interventions at a time. The researchers used Bayesian mixed treatment comparisons to provide, "for the first time, the probability of an outcome at the end of one year of treatment as well as a rank for all treatments."
That said, they point out that antiviral treatment of chronic hepatitis B frequently continues for much longer than 1 year, sometimes for a lifetime. Hence, the current results "are not sufficient to definitively resolve the question of optimal treatment choice."