网络Meta分析：抗病毒治疗在预防乙肝的母婴传播疗效比较

StephenW

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.

StephenW

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，*

DOI：10.1111 / liv.12959

这篇文章是受版权保护的。版权所有。

问题
封面图片卷。 35第9期
肝国际

接受第（接受，未编辑的文章在网上和可引用出版。最后编辑记录的排版本将出现在未来的。）

    1部分消化疾病，美国耶鲁大学医学院，纽黑文，CT，美国的
    2胃肠病学和肝病，佛罗里达大学盖恩斯维尔，佛罗里达，美国
    3胃肠病学和肝病，梅奥诊所，明尼苏达州罗彻斯特市，美国
    4科临床病理学，喀麦隆
    5侦查医学项目，临床研究的耶鲁中心，纽黑文，CT，美国

*条担保人：
约瑟夫·K。林，MD
医学副教授;
董事，耶鲁大学病毒性肝炎计划
333雪松街，
纽黑文，CT 06520
[email protected]

    这篇文章已被接受发表，并经过充分的同行评审，但经过审稿，排版，分页和校对过程中，这可能会导致这个版本和记录的版本之间的差异还没有。请引用这篇文章的DOI：10.1111 / liv.12959


抽象的
底

抗病毒药物是安全和有效在孕晚期防止乙型肝炎病毒宫内传输，并且被推荐用于HBV感染母亲妊娠（周28和32之间）与高病毒载量，随后产后乙肝免疫的新生儿。我们估计抗病毒药物的疗效比较预防乙肝病毒的垂直传播，通过网络汇总分析的临床试验。
方法

我们进行了从大的肝会议全面检索MEDLINE，文摘的出版程序，从1980年1月2014年11月，我们对于任何给定对进行利用马尔可夫链蒙特卡罗方法，结合直接和间接的证据成对荟萃分析和贝叶斯框架护理服务。
结果

十七涉及2,764新生儿乙肝表面抗原阳性母亲的临床试验有资格进行分析。目前还没有涉及替诺福韦和恩替卡韦的临床试验。在成对的荟萃分析中，替比夫定（HR 0.12，95％CI为0.04〜0.37; I2 = 0％），和拉米夫定（HR 0.40，95％CI为0.24〜0.65; I2 = 0％），比安慰剂更有效在减少病毒血症高HBeAg阳性慢性乙肝中国患者乙肝病毒的垂直传播。敏感性分析，以有限的HBeAg阳性的研究揭示了母亲相似的结果。
结论

基于贝叶斯网络荟萃分析的临床试验中，结合直接和间接的治疗比较，替比夫定似乎用于预防HBV感染的垂直传播比拉米夫定更有效。试验评估替诺福韦和恩替卡韦的疗效比安慰剂或其他抗病毒药物缺乏。

这篇文章是受版权保护的。版权所有。