恩替卡韦与替诺福韦治疗的慢性乙型肝炎患者之间的肝细胞

StephenW

No difference in hepatocellular carcinoma risk between chronic hepatitis B patients treated with entecavir versus tenofovir

    http://orcid.org/0000-0002-7707-1072Feng Su1, Kristin Berry2, George N Ioannou1,2,3

Author affiliations

    Division of Gastroenterology, University of Washington, Seattle, Washington, USA
    Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA
    Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA

    Correspondence to Dr Feng Su, University of Washington, Seattle, WA 98195-0005, USA; [email protected]

Abstract

Objective Entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are first-line agents for the treatment of chronic hepatitis B (CHB). Recent studies have challenged the assumption that these agents are equally effective at preventing hepatocellular carcinoma (HCC). We aimed to determine whether the risk of HCC and mortality differ in patients with CHB treated with ETV and TDF.

Design We performed a retrospective cohort study of Veterans Affairs patients with CHB in the USA who initiated treatment with ETV or TDF between the dates of Food and Drug Administration approval of these medications and 1 January 2017. Multivariable Cox proportional hazards regression was used to determine the association between antiviral therapy and HCC risk as well as the risk of death or liver transplantation. Propensity score adjustment and competing risks analysis were performed.

Results We identified 2193 ETV-treated and 1094 TDF-treated patients who were followed for a mean of 5.4 years. We found no difference in the risk of HCC in ETV-treated versus TDF-treated patients (adjusted HR (aHR) 1.00, 95% CI 0.76 to 1.32). Results were similar in propensity score adjusted and competing risks analysis, and in multiple sensitivity analyses. We also found no difference in the risk of death or liver transplantation (aHR 1.16, 95% CI 0.98 to 1.39).

Conclusions We found no difference in the risk of HCC between patients with CHB treated with ETV versus TDF. Our results support current guideline recommendations that both agents are appropriate first-line options for the treatment of CHB.
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http://dx.doi.org/10.1136/gutjnl-2019-319867

StephenW

恩替卡韦与替诺福韦治疗的慢性乙型肝炎患者之间的肝细胞癌风险无差异

    http://orcid.org/0000-0002-7707-1072Feng Su1，Kristin Berry2，George N Ioannou1,2,3

作者单位

    华盛顿大学胃肠病学系，西雅图，美国华盛顿
    退伍军人事务普吉特海湾医疗保健系统卫生服务研究与开发，美国华盛顿州西雅图
    退伍军人事务普吉特海湾医疗保健系统胃肠病学科，美国华盛顿州西雅图

    通讯作者：美国华盛顿华盛顿大学华盛顿大学的苏凤博士，邮编98195-0005； [email protected]

抽象

目的恩替卡韦（ETV）和替诺福韦富马酸替索罗非酯（TDF）是治疗慢性乙型肝炎（CHB）的一线药物。最近的研究挑战了这些药物在预防肝细胞癌（HCC）中同样有效的假设。我们旨在确定接受ETV和TDF治疗的CHB患者的HCC风险和死亡率是否存在差异。

设计我们进行了一项回顾性队列研究，研究对象是美国食品和药物管理局批准这些日期至2017年1月1日之间开始接受ETV或TDF治疗的美国CHB退伍军人事务患者。采用多变量Cox比例风险回归来确定抗病毒治疗与HCC风险以及死亡或肝移植风险之间的相关性。进行了倾向得分调整和竞争风险分析。

结果我们确定了2193例接受ETV治疗和1094例TDF治疗的患者，平均随访时间为5.4年。我们发现，经ETV治疗的患者与经TDF治疗的患者的肝癌风险无差异（校正后的HR（aHR）1.00，95％CI 0.76至1.32）。在倾向评分调整和竞争风险分析以及多重敏感性分析中，结果相似。我们也没有发现死亡或肝移植风险的差异（aHR 1.16，95％CI 0.98至1.39）。

结论我们发现，ETV与TDF治疗的CHB患者之间的HCC风险无差异。我们的结果支持当前的指南建议，即两种药物都是治疗CHB的适当一线选择。
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http://dx.doi.org/10.1136/gutjnl-2019-319867