一个系统的回顾和贝叶斯网络荟萃分析：抗病毒治疗乙肝的

StephenW

Eur J Gastroenterol Hepatol. 2015 Aug;27(8):882-94. doi: 10.1097/MEG.0000000000000376.
Comparative effectiveness of antiviral treatment for hepatitis B: a systematic review and Bayesian network meta-analysis.Govan L1, Wu O, Xin Y, Hutchinson SJ, Hawkins N.
Author information

• 1aHealth Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow bSchool of Health & Life Sciences, Glasgow Caledonian University, Glasgow cOxford Outcomes, Oxford, UK.
  

AbstractOBJECTIVE: A wide variety of competing drugs are available to patients for the treatment of chronic hepatitis B. We update a recent meta-analysis to include additional trial evidence with the aim of determining which treatment is the most effective.
METHODS: Twelve monotherapy or combination therapy were evaluated in treatment-naive individuals with hepatitis B e antigen (HBeAg) positive or negative patients. Databases were searched for randomized controlled trials in the first year of therapy. Bayesian random effects network meta-analysis was used to calculate the pairwise odds ratios, 95% credible intervals and ranking of six surrogate outcomes.
RESULTS: In total, 22 studies were identified (7508 patients): 12 studies analysed HBeAg-positive patients, six analysed HBeAg-negative patients, and four evaluated both. Tenofovir was most effective at increasing efficacy in HBeAg-positive patients, ranking first for three outcomes and increased odds of undetectable levels of hepatitis B virus (HBV) DNA compared with seven other therapies (such as lamivudine: odds ratio 33.0; 95% credible interval 7.0-292.7). For HBeAg-negative patients, the large network (seven therapies) ranked entecavir alone or in combination with tenofovir highly for reduction in HBV DNA and histologic improvement. In the smaller network (three therapies), tenofovir ranked first for undetectable HBV DNA and histologic improvement. No data existed to directly or indirectly compare these treatments.
CONCLUSION: For HBeAg-positive patients tenofovir is the most effective at increasing efficacy, whereas for HBeAg-negative patients, either tenofovir or entecavir is most effective. Further research should focus on strengthening the network connections, in particular comparing tenofovir and entecavir in HBeAg-negative patients.

StephenW

欧元J Gastroenterol肝脏病杂志。 2015年八月; 27（8）：882-94。 DOI：10.1097 / MEG.0000000000000376。
一个系统的回顾和贝叶斯网络荟萃分析：抗病毒治疗乙肝的比较效益。
戈万L1，吴O，鑫Y，哈钦森SJ，霍金斯N.
作者信息

    1aHealth经济学和卫生技术评估，健康和福利，格拉斯哥苏格兰格拉斯哥大学bSchool的健康与生命科学学院，大学，格拉斯哥cOxford结果，英国牛津学院。

抽象
目的：

各种各样的竞争药物可用于患者慢性乙型肝炎的治疗，我们更新最近的荟萃分析以包括额外的试验的证据以确定哪个治疗是最有效的目的。
方法：

在治疗过的个体与乙型肝炎e抗原（HBeAg）阳性或阴性患者十二单一疗法或组合疗法进行了评价。数据库中搜索在治疗的第一年的随机对照试验。贝叶斯随机效应网络荟萃分析来计算成对的比值比，95％可信区间和六个替代结果排名。
结果：

总共22项研究进行鉴定（7508例）：12项研究进行分析HBeAg阳性患者，六分析HBeAg阴性的患者，和四个评估两者。替诺福韦是最有效的是提高疗效的HBeAg阳性患者，排名第一的三项成果和乙肝病毒检测不到的水平的几率增加与其他七个疗法（如拉米夫定（HBV）DNA进行比较：比值比33.0; 95％可信区间7.0-292.7）。对于HBeAg阴性患者中，大网络（7疗法）排名恩替卡韦单独或与替诺福韦高度为减少HBV DNA和组织学改善的组合。在较小的网络（三级疗法），替诺福韦排名第一的探测不到的HBV DNA和组织学改善。没有任何数据存在直接或间接比较这些治疗方法。
结论：

对于HBeAg阳性患者替诺福韦是提高疗效的最有效的，而对于HBeAg阴性患者，替诺福韦或恩替卡韦是最有效的。进一步的研究应重点加强的网络连接，尤其是在HBeAg阴性患者比较替诺福韦和恩替卡韦。