比较恩替卡韦和替诺福韦在核苷（t）类似物初始慢性乙型肝

StephenW

Clin Microbiol Infect. 2017 Feb 9. pii: S1198-743X(17)30089-7. doi: 10.1016/j.cmi.2017.02.001. [Epub ahead of print]
Comparison of the efficacy and safety of entecavir and tenofovir in nucleos(t)ide analogue-naïve chronic hepatitis B patients with high viremia: a retrospective cohort study.Wu IT1, Hu TH1, Hung CH1, Lu SN1, Wang JH1, Lee CM1, Chen CH2.
Author information

• 1Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan.
• 2Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan. Electronic address: [email protected].
  

AbstractOBJECTIVES: The aims of this study are to compare the long-term efficacy and safety of entecavir (ETV) and tenofovir (TDF) in nucleos(t)ide analogue (NA)-naïve chronic hepatitis B (CHB) patients with high HBV DNA (>6 log10 IU/mL).
METHODS: We recruited 419 NA-naïve patients for analysis (313 ETV, 106 TDF). We used propensity score matching to match 106 patients in TDF group with 212 patients in ETV group by age, baseline HBV DNA levels and cirrhosis after subgrouping by HBeAg status.
RESULTS: There was no significant difference in 3-year cumulative rates of virological response (VR) (96.4% vs. 92.1%, P=0.26 in HBeAg-positive or 98.2% vs. 98.6%, P=0.64 in HBeAg-negative patients), HBeAg loss (53.8% vs. 47.4%, P=0.89) or seroconversion (40.2% vs. 41.3%, P=0.77), and hepatocellular carcinoma (HCC) development (4% vs. 2.7%, P=0.55) between the TDF and ETV groups in either cohort or propensity-score matching patients. In subgroup analysis of patients with HBV DNA>108 IU/mL, ETV and TDF showed similar effectiveness in achieving VR (90.9% vs. 87.7% at 3 year; P=0.13). TDF and diabetes mellitus were independent factors for acute kidney injury (AKI) during treatment. Multivariate analysis showed that HBeAg-negative status, and lower baseline HBV DNA and HBsAg levels were independent factors for achieving VR. Older age, lower baseline HBV DNA levels, cirrhosis and α-fetoprotein ≥8 ng/mL at 12 months of treatment were independently associated with HCC development.
CONCLUSIONS: TDF and ETV have similar effectiveness in NA-naïve CHB patients with high viremia. TDF might have a higher incidence of AKI compared with ETV during treatment.

Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

KEYWORDS: Chronic hepatitis B; Entecavir; Tenofovir; acute kidney injury; hepatocellular carcinoma

PMID:28189857DOI:10.1016/j.cmi.2017.02.001

StephenW

Clin Microbiol Infect。 2017 Feb 9. pii：S1198-743X（17）30089-7。 doi：10.1016 / j.cmi.2017.02.001。 [印刷前电子版]
比较恩替卡韦和替诺福韦在核苷（t）类似物初始慢性乙型肝炎患者高病毒血症的疗效和安全性：回顾性队列研究。
Wu IT1，Hu TH1，Hung CH1，Lu SN1，Wang JH1，Lee CM1，Chen CH2。
作者信息

    高雄长庚纪念医院和长庚大学医学院台湾肝内科，胃内科，内科系。
    高雄长庚纪念医院和长庚大学医学院台湾肝内科，肝内科，内科，2医学。电子地址：[email protected]。

抽象
目标：

本研究的目的是比较恩替卡韦（ETV）和替诺福韦（TDF）在核型（t）类似物（NA） - 慢性乙型肝炎（CHB）高HBV DNA（>）的长期疗效和安全性， 6 log 10 IU / mL）。
方法：

我们招募了419名无NA的初始患者进行分析（313 ETV，106 TDF）。我们使用倾向评分匹配来匹配106名患者的TDF组，212名ETV组的患者，年龄，基线HBV DNA水平和肝硬化后亚组HBeAg状态。
结果：

病毒学应答（VR）的3年累积率（96.4％对92.1％，HBeAg阳性的P = 0.26，HBeAg阴性患者的98.2％对98.6％，P = 0.64）没有显着差异，在肝脏中的HBeAg水平（53.8％对47.4％，P = 0.89）或血清转换（40.2％对41.3％，P = 0.77）和肝细胞癌TDF和ETV组在队列或倾向评分匹配患者。在HBV DNA> 108 IU / mL的亚组分析中，ETV和TDF在实现VR方面表现出类似的效果（90.9％对比3年的87.7％; P = 0.13）。 TDF和糖尿病是治疗期间急性肾损伤（AKI）的独立因素。多变量分析显示，HBeAg阴性状态，较低的基线HBV DNA和HBsAg水平是实现VR的独立因素。在12个月的治疗中，年龄较大，基线HBV DNA水平，肝硬化和α-胎蛋白≥8ng / mL与HCC发展独立相关。
结论：

TDF和ETV在具有高病毒血症的无NA的初次CHB患者中具有相似的有效性。与治疗期间的ETV相比，TDF可能具有更高的AKI发生率。

版权所有©2017欧洲临床微生物学与传染病学会。发布者Elsevier Ltd.保留所有权利。
关键词：

慢性乙型肝炎;恩替卡韦替诺福韦;急性肾损伤;肝细胞癌

PMID：
    28189857
DOI：
    10.1016 / j.cmi.2017.02.001