AASLD2016[1891]替诺（TDF）和恩替(ETV)的肾脏安全性比较： Meta分

StephenW

1891
Comparison of Renal safety of Tenofovir (TDF) and Entecavir
(ETV) in Patients with Chronic Hepatitis B (CHB):
A Systematic Review with Meta-Analysis
Hyo Young Lee1, Dae Won Jun1, Ramsey Cheung2, Mindie H.
Nguyen2; 1Department of Internal Medicine, Hanyang University
Hospital, Seoul, Korea (the Republic of); 2Division of Gastroenterology
and Hepatology, Stanford University Medical center, Palo
Alto, CA
Background/Aims: Recent meta-analyses showed similar efficacy
of TDF and ETV in CHB patients. However there is a paucity
of studies on comparing the long term renal effect of these
two drugs. Methods: Two investigators independently searched
the Cochrane library, MEDLINE, and EMBASE databases was
up until March 2016, for randomized controlled trials(RCT)
and non-randomized studies (NRSs) using key words, with;
additional references obtained from relevant article bibliography.
We also searched for relevant abstracts from AASLD,
EASL, APASL and DDW 2014 and 2016. We assessed study
quality with a modified Newcastle-Ottawa scale for NRS and
the Risk of bias of Cochrane for RCTs. Results: No RCT was
found. Seven NRSs (2312 participants) met the inclusion criteria
and were included in this meta-analysis. Using a random
effects approach, there was a higher increase in serum creatinine
in TDF compared to ETV group at 6 months (Z=9.16;
p<0.00001), 12months (Z=4.48; p<0.00001) and 24 months
(Z=5.87; p<0.00001) respectively (Figure 1). The absolute
change value of creatinine was 0.07, 0.07 and 0.04mg/dl
respectively. The changes of serum estimated glomerular filtration
rate (eGFR) were also increased in TDF group at 6 months
(Z=2.65; p=0.008), 12months (Z=3.46; p=0.0005) and
24 months (Z=4.54; p<0.00001) respectively. The absolute
change value of eGFR was 5.0, 6.77 and 9.66 respectively.
Conclusions: In CHB patients, TDF resulted in a statistically significant
increase in serum creatinine and eGFR by comparison
with ETV. Since the absolute increase is low for parameters up
to 24-month follow-up, clinical significance of the findings is
unclear in the short-term. However, further studies are needed
to examine the long-term renal effect of TDF since antiviral
therapy is generally long-term to life-long for CHB in indicated
patients.
Figure 1.
Disclosures:
Ramsey Cheung - Grant/Research Support: Gilead Sciences, AbbVie
Mindie H. Nguyen - Advisory Committees or Review Panels: Bristol-Myers
Squibb, Gilead; Consulting: Gilead Sciences, Inc.; Grant/Research Support:
Gilead Sciences, Inc., Bristol-Myers Squibb

StephenW

AASLD2016替诺福韦（TDF）和恩替卡韦的肾脏安全性比较
（ETV）在慢性乙型肝炎（CHB）患者：
Meta分析的系统评价
替诺福韦（TDF）和恩替卡韦的肾脏安全性比较
（ETV）在慢性乙型肝炎（CHB）患者：
Meta分析的系统评价
Hyo Young Lee1，Dae Won Jun1，Ramsey Cheung2，Mindie H.
Nguyen2; 1.汉阳大学内科学系
医院，韩国首尔（共和国）;胃肠病学
和肝病，斯坦福大学医学中心，帕洛
Alto，CA
背景/目的：最近的荟萃分析显示类似的疗效
的TDF和ETV在CHB患者。但是有一个缺乏
的比较这些长期肾脏效应的研究
两种药。方法：两名研究者独立搜索
Cochrane文库，MEDLINE和EMBASE数据库
直到2016年3月，随机对照试验（RCT）
和使用关键词的非随机研究（NRS），与;
从相关文献参考文献获得的附加参考文献。
我们还搜索了来自AASLD的相关摘要，
EASL，APASL和DDW 2014和2016年。我们评估研究
质量与修改的纽卡斯尔 - 渥太华规模为NRS和
Cochrane对RCT的偏倚风险。结果：无RCT
发现。 7个NRS（2312名参与者）符合纳入标准
并纳入本荟萃分析。使用随机
效应方法，血清肌酐升高较多
在TDF相比ETV组在6个月（Z = 9.16;
p <0.00001），12个月（Z = 4.48; p <0.00001）和24个月
（Z = 5.87; p <0.00001）（图1）。绝对
肌酐的变化值为0.07,0.07和0.04mg / dl
分别。血清估计肾小球滤过的变化
率（eGFR）也在6个月增加TDF组
（Z = 2.65; p = 0.008），12个月（Z = 3.46; p = 0.0005）
24个月（Z = 4.54; p <0.00001）。绝对
eGFR的变化值分别为5.0,6.77和9.66。
结论：在CHB患者中，TDF导致统计学显着
通过比较增加血清肌酐和eGFR
与ETV。因为参数增加的绝对增加较低
到24个月随访，临床意义的发现是
在短期内不清楚。然而，需要进一步的研究
以检查TDF自抗病毒后的长期肾脏效应
治疗一般为长期到终身为CHB的指示
耐心。
图1。
披露：
Ramsey Cheung - 资助/研究支持：Gilead Sciences，AbbVie
Mindie H. Nguyen - 咨询委员会或审查小组：Bristol-Myers
Squibb，Gilead;咨询：吉利德科学有限公司;资助/研究支持：
吉利德科学公司，Bristol-Myers Squibb

kite2002005

好吧，到底哪个肾毒性小，说说清楚。。

csfluke

回复 kite2002005 的帖子

看这论文，明显恩替肾毒性小于替诺