Comparative effectiveness of antiviral treatment for hepatitis B: a systematic review and Bayesian network meta-analysis

Govan, L. , Wu, O. , Xin, Y. , Hutchinson, S. J. and Hawkins, N. (2015) Comparative effectiveness of antiviral treatment for hepatitis B: a systematic review and Bayesian network meta-analysis. European Journal of Gastroenterology and Hepatology, 27(8), pp. 882-894. (doi:10.1097/meg.0000000000000376) (PMID:25919772)

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Abstract

Objective A wide variety of competing drugs are available to patients for the treatment of chronic hepatitis B. We update a recent meta-analysis to include additional trial evidence with the aim of determining which treatment is the most effective. Methods Twelve monotherapy or combination therapy were evaluated in treatment-naive individuals with hepatitis B e antigen (HBeAg) positive or negative patients. Databases were searched for randomized controlled trials in the first year of therapy. Bayesian random effects network meta-analysis was used to calculate the pairwise odds ratios, 95% credible intervals and ranking of six surrogate outcomes. Results In total, 22 studies were identified (7508 patients): 12 studies analysed HBeAg-positive patients, six analysed HBeAgnegative patients, and four evaluated both. Tenofovir was most effective at increasing efficacy in HBeAg-positive patients, ranking first for three outcomes and increased odds of undetectable levels of hepatitis B virus (HBV) DNA compared with seven other therapies (such as lamivudine: odds ratio 33.0; 95% credible interval 7.0–292.7). For HBeAg-negative patients, the large network (seven therapies) ranked entecavir alone or in combination with tenofovir highly for reduction in HBV DNA and histologic improvement. In the smaller network (three therapies), tenofovir ranked first for undetectable HBV DNA and histologic improvement. No data existed to directly or indirectly compare these treatments. Conclusion For HBeAg-positive patients tenofovir is the most effective at increasing efficacy, whereas for HBeAg-negative patients, either tenofovir or entecavir is most effective. Further research should focus on strengthening the network connections, in particular comparing tenofovir and entecavir in HBeAg-negative patients.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Hawkins, Professor Neil and Xin, Miss Yiqiao and Wu, Professor Olivia and Govan, Dr Lindsay
Authors: Govan, L., Wu, O., Xin, Y., Hutchinson, S. J., and Hawkins, N.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
Journal Name:European Journal of Gastroenterology and Hepatology
Publisher:Lippincott Williams & Wilkins
ISSN:0954-691X
ISSN (Online):1473-5687

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