Comparative Efficacy of Antiviral Therapy in Preventing Vertical Transmission of Hepatitis B: A Network Meta-analysis
B. Njei1,5, N. Gupta2, O. Ewelukwa, I. Ditah3, M. Foma4 andJ.K. Lim1,*
DOI: 10.1111/liv.12959
This article is protected by copyright. All rights reserved.
Issue
Cover image for Vol. 35 Issue 9
Liver International
Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)
1 Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, United States
2 Gastroenterology and Hepatology, University of Florida, Gainesville, FL, United States
3 Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
4 Division of Clinical Pathology, Cameroon
5 Investigative Medicine Program, Yale Center of Clinical Investigation, New Haven, CT, United States
* Guarantor of Article:
Joseph K. Lim, MD
Associate Professor of Medicine;
Director, Yale Viral Hepatitis Program
333 Cedar St,
New Haven, CT 06520 [email protected]
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/liv.12959
Abstract
Background
Antiviral drugs are safe and effective in the third trimester to prevent intrauterine transmission of hepatitis B virus, and are recommended for HBV infected gravid mothers (between weeks 28 and 32) with high viral load, followed by postnatal hepatitis B immunization in the newborn. We estimated the comparative efficacy of antiviral drugs for prevention of vertical transmission of HBV, through a network meta-analysis of clinical trials.
Methods
We conducted a comprehensive search of MEDLINE, EMBASE and published proceedings from major liver meetings from January 1980 to November 2014. We conducted pair-wise meta-analyses and Bayesian framework using Markov chain Monte Carlo methods, combining direct and indirect evidence for any given pair of treatments.
Results
Seventeen clinical trials involving 2,764 newborns of HBsAg seropositive mothers were eligible for analysis. There were no clinical trials involving Tenofovir or Entecavir. On pair-wise meta-analyses, Telbivudine (HR 0.12, 95% CI 0.04 to 0.37; I2 = 0%), and Lamivudine (HR 0.40, 95% CI 0.24 to 0.65; I2 = 0%), were more effective than placebo in reducing vertical transmission of HBV in high viremic HBeAg-positive chronic Hepatitis B Chinese patients. Sensitivity analyses limited to studies with HBeAg seropositive mothers revealed similar results.
Conclusion
Based on a Bayesian network meta-analysis of clinical trials, combining direct and indirect treatment comparisons, Telbivudine appears to be more effective than Lamivudine for preventing vertical transmission of HBV infection. Trials assessing the efficacy of Tenofovir or Entecavir compared to placebo or other antiviral drugs are lacking.
This article is protected by copyright. All rights reserved.
作者: StephenW 时间: 2015-9-11 15:36
网络Meta分析：抗病毒治疗在预防乙肝的母婴传播疗效比较
B. Njei1,5，N. Gupta2，澳Ewelukwa，一Ditah3，M Foma4 andJ.K. LIM1，*