恩替卡韋或替諾福韋富馬酸替諾福韋治療慢性乙型肝炎的肝

StephenW

Hepatocellular carcinoma and death and transplantation in chronic hepatitis B treated with entecavir or tenofovir disoproxil fumarate
Yeonjung Ha  1 , Young Eun Chon  2 , Mi Na Kim  2 , Joo Ho Lee  2 , Seong Gyu Hwang  2
Affiliations
Affiliations

    1
    Department of Gastroenterology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, South Korea. [email protected].
    2
    Department of Gastroenterology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, South Korea.

    PMID: 32782369 DOI: 10.1038/s41598-020-70433-z

Abstract

Conflicting results have been reported regarding which of entecavir (ETV) or tenofovir disoproxil fumarate (TDF) is associated with better outcomes. Chronic hepatitis B patients who started ETV or TDF between 2010 and 2015 were analysed. The primary outcomes were hepatocellular carcinoma and death and transplantation. The impact of the treatment on the primary outcomes was analysed using Cox proportional hazards models in the entire and propensity score-matched cohorts. A total of 404 patients (180 and 224 in the ETV and TDF groups, respectively) were analysed. The median duration of follow-up was significantly longer in the ETV group (64.0 vs. 49.1 months; P < 0.001). Virological response (79.4% vs. 68.4%; P = 0.018) and sustained virological suppression (59.7% vs. 45.2%; P = 0.005) were significantly higher in the TDF group. TDF was associated with lower hepatocellular carcinoma [hazard ratio (HR) 0.31, 95% confidence interval (95% CI), 0.12‒0.79; P = 0.014]; however, statistical significance was not reached after adjusting sustained virological suppression using propensity score matching (HR 0.36, 95% CI 0.12‒1.14; P = 0.08). Death and transplantation was comparable. In conclusion, the impact of TDF on the lower hepatocellular carcinoma was blunted after adjusting sustained virological suppression. Further comparison in a larger number of patients who show sustained virological suppression over a longer period of time is needed.

StephenW

恩替卡韋或替諾福韋富馬酸替諾福韋治療慢性乙型肝炎的肝細胞癌及死亡和移植
Yeonjung Ha 1，Young Eun Chon 2，Mi Na Kim 2，Joo Ho Lee 2，Seong Gyu Hwang 2
隸屬關係
隸屬關係

    1個
    韓國京畿道城南市盆唐區八一路59號CHA大學CHA盆唐醫學中心消化內科，13496。 [email protected]。
    2
    韓國京畿道城南市盆唐區八一路59號CHA大學CHA盆唐醫學中心消化內科，13496。

    PMID：32782369 DOI：10.1038 / s41598-020-70433-z

抽象

關於恩替卡韋（ETV）或替諾福韋富馬酸替諾福韋（TDF）與更好的結局相關的報導相矛盾。對2010年至2015年開始接受ETV或TDF治療的慢性乙型肝炎患者進行了分析。主要結局是肝細胞癌以及死亡和移植。在整個和傾向得分匹配的隊列中，使用Cox比例風險模型分析了治療對主要結局的影響。總共分析了404例患者（ETV和TDF組分別為180例和224例）。 ETV組的中位隨訪時間明顯更長（64.0 vs. 49.1個月； P <0.001）。 TDF組的病毒學應答（79.4％vs. 68.4％； P = 0.018）和持續病毒抑制（59.7％vs. 45.2％； P = 0.005）明顯更高。 TDF與較低的肝細胞癌相關[危險比（HR）0.31，95％置信區間（95％CI），0.12‒0.79； P = 0.014]；然而，使用傾向評分匹配調整持續病毒抑制後，仍未達到統計學意義（HR 0.36，95％CI 0.12 0.11.14； P = 0.08）。死亡和移植可比。總之，調整持續的病毒學抑制後，TDF對下層肝細胞癌的影響減弱了。需要對更多的在較長時期內顯示出持續的病毒學抑制的患者進行進一步比較。

StephenW

https://www.nature.com/articles/s41598-020-70433-z.pdf