Tenofovir treatment has lower risk of hepatocellular carcinoma than entecavir treatment in patients with chronic hepatitis B
Refereed conference paper presented and published in conference proceedings


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摘要Background and Aim:
Both tenofovir disoproxil fumarate (TDF) and entecavir (ETV) have potent antiviral effect on hepatitis B virus, and are recommended as the first-line treatment for chronic hepatitis B (CHB). A recent study suggested that patients who received TDF treatment have lower risk of hepatocellular carcinoma (HCC) than those who received ETV. We aimed to compare TDF and ETV on the risk of HCC in a territory-wide cohort of CHB patients.

Method:
Consecutive adult CHB patients who were initially treated with ETV or TDF for at least 6 months between January 2008 and December 2018 were identified using the Clinical Data Analysis and Reporting System that captures in-patient and out-patient data of all public hospitals and clinics in Hong Kong. Patients who had cancers or liver transplantation before or within the first 6 months of treatment were excluded. Missing data were replaced by multiple imputation (MI) by chained equations to create 20 complete data sets after 10 iterations. Propensity score (PS) weighting was used after MI to balance the baseline clinical characteristics between two treatment groups; PS included all covariates in the multivariable analysis (Table), serum creatinine, and renal replacement therapy. Fine-Gray model was used to adjust for competing risk of death.

Results:
29,123 CHB patients were identified. Their mean age was 53.7±13.3 years, 18,492 (63.5%) were male; 1,227 (4.2%) and 27,896 (95.8%) first received TDF and ETV, respectively. TDF-treated patients were younger (43.7 vs. 54.1 years) and less likely to be cirrhotic (28 [2.3%] vs. 3,524 [12.6%]). At a median (interquartile range) follow-up of 3.3 (1.6–5.0) years, 9 (0.7%) TDF-treated and 1,468 (5.3%) ETV-treated patients developed HCC. The 5-year cumulative incidence (95% confidence interval [CI]) of HCC in TDF-treated and ETV -treated patients was 1.3% (0.6%-2.6%) and 7.5% (7.1%-7.9%), respectively (Figure). TDF use was associated with a lower risk of HCC than ETV use before (adjusted hazard ratio [aHR] 0.46, 95% CI 0.23-0.91, P=0.027) and after multiple imputation, with (weighted HR 0.40, 95% CI 0.18-0.86, P=0.019) and without (aHR 0.34, 95% CI 0.18-0.66, P=0.001) PS weighting (Table).

Conclusion:
TDF treatment is associated with a lower risk of HCC than ETV treatment in a territory-wide cohort of CHB patients.
著者Terry Cheuk-Fung Yip, Vincent Wai-Sun Wong, Yee-Kit Tse, Henry Lik-Yuen Chan, Grace Lai-Hung Wong
會議名稱European Association for the Study of the Liver (EASL) The International Liver Congress™ 2019
會議開始日10.04.2019
會議完結日14.04.2019
會議地點Vienna
會議國家/地區奧地利
會議論文集題名Journal of Hepatology
出版年份2019
月份4
卷號70
期次Suppl 1
出版社Elsevier
頁次E128 - E128
國際標準期刊號0168-8278
電子國際標準期刊號1600-0641
語言英式英語

上次更新時間 2020-05-08 於 06:01