by Molly Walker, Staff Writer, MedPage Today April 14, 2019
This article is a collaboration between MedPage Today® and:
VIENNA -- Patients in Hong Kong with chronic hepatitis B virus (HBV) infection were less likely to develop hepatocellular carcinoma (HCC) with tenofovir disoproxil fumarate (TDF) therapy compared with entecavir (ETV), a researcher said here.
Compared with ETV (Baraclude) treatment, TDF (Viread and Vemlidy) treatment was linked with a lower risk of HCC (adjusted subdistribution HR 0.32, 95% CI 0.16-0.65), reported Terry Cheuk Fung Yip, PhD, of The Chinese University in Hong Kong, at the European Association for the Study of the Liver(EASL) annual meeting.
This late-breaking trial was the second one presented at EASL to discover this association. "A very interesting study was presented by a Korean group suggested that TDF-treated patients have a lower risk of developing HCC than those who receive ETV. This raises the question about whether TDF and ETV would have a similar or different risk reduction," Yip said at an EASL press conference.
Yip's group examined inpatient and outpatient data over a 10-year period from all Hong Kong public hospitals and clinics. Missing data were replaced by multiple imputation, and then propensity score weighting was used to balance clinical characteristics between two treatment groups, the authors said.
Overall, 29,350 patients were identified (mean age about 53l; about two-thirds men). However, more than 95% first received entecavir versus tenofovir disoproxil fumarate for chronic HBV infection. At a median of 6 years follow-up, eight patients (0.6%) on TDF developed HCC compared to 1,386 (4.9%) of patients on ETV.
The 5-year cumulative incidence of HCC was 7.0% (95% CI 6.6-7.3) in the ETV group versus 1.1% (95% CI 0.5-2.3). This association remained robust in the propensity score weighting analysis, the authors noted (adjusted SHR 0.36, 95% CI 0.16-0.80, P=0.013). MedPage Today asked EASL press conference moderator Francesco Negro, MD, of the University Hospital of Geneva, if he would switch his patients from ETV to TDF, Negro responded with caution.
"It's a challenging question, because we now have two sets of data suggesting this [difference with TDF]. I do not know the answer to this question; it is too early," he said.
Gregory Dore, MBBS, PhD, of the University of New South Wales in Sydney was not involved in the study, but chimed in with some caveats.
"A very small portion of patients were on tenofovir, and they were presumably at different income levels than patients on entecavir," he said. "There may also be other factors that were not tested for in the propensity score analysis -- alcohol intake, for example, is an important risk factor, and there are many other factors that need to be further explored."
Yip cited a late-breaker EASLposter presentation from Stuart C. Gordon, MD, of Henry Ford Hospital in Detroit, and colleagues that found that the risk of HCC for patients treated with TDF versus ETV may vary by race group. Specifically, Gordon's group found a trend towards risk reduction in Asian patients, consistent with both the Korean study and the findings from Yip's group.
Yip said the differences could be due to immunology or perhaps the reason is more virological, where "TDF can perhaps clear the virus more rapidly."
Currently, ETV and TDF are equally recommended as first-line treatments for chronic HBV, the authors noted. Negro added that "I don't think we're ready to include this data in the guidelines, but we will be following the data very, very carefully." 作者: StephenW 时间: 2019-4-15 16:18
