medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2013, Number 3

<< Back Next >>

Ann Hepatol 2013; 12 (3)

The efficacy and safety of nucleos(t)ide analogues in the treatment of HBV-related acute-on-chronic liver failure: a meta-analysis

Shi Y, He J, Wu W, Huang J, Yang Y, Sheng J, Yu L, Chen Z, Jia H

Language: English
References: 25
Page: 364-372
PDF size: 147.46 Kb.


ABSTRACT

Introduction.The application of nucleos(t)ide analogues in hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) has not yet been widely accepted. Therefore, we conducted a meta-analysis of prospective and retrospective studies to examine the efficacy and safety of nucleos(t)ide analogues in treating HBV-related ACLF. Material and methods. Two independent reviewers identified eligible studies through electronic, and manual searches, and contact with experts. Three-month mortality was defined as the primary efficacy measure. ACLF reactivation and HBV DNA inhibition were secondary efficacy measures. Quantitative meta-analyses were performed to compare differences between nucleos(t)ide analogue and control groups. Results. Five eligible studies were identified. Antiviral treatment with nucleos(t)ide analogues led to significant reduction of HBV DNA [HBV DNA reduction › 2 log: 70.4 vs. 29%, RR = 2.29, 95%CI (1.49, 3.53), P ‹ 0.01]. ACLF patients receiving nucleos(t)ide analogue had significantly lower 3-month mortality [44.8 vs. 73.3%, RR = 0.68, 95%CI (0.54, 0.84), P ‹ 0.01] as well as incidence of reactivation [1.80 vs. 18.4%, RR = 0.11, 95%CI (0.03, 0.43), P ‹ 0.01] compared to those who did not. There was no significant difference in the prognosis of patients treated with entecavir or lamivudine [36.4 vs. 40.5%, RR = 0.77, 95%CI (0.45, 1.32), P = 0.35]. No drug-related adverse events were reported during follow-up. Conclusion. Our findings suggest that nucleos(t)ide analogue treatment reduces short-term mortality as well as reactivation of HBV-related ACLF patients. Nucleos(t)ide analogues are well-tolerated during therapy, and suggestive evidence indicates that entecavir and lamivudine confer comparable short-term benefits in these patients. However, further studies are needed to clarify these observations.


REFERENCES

  1. Lok ASF, McMahon BJ. Chronic hepatitis B: Update 2009. Hepatology 2009; 50: 661-2.

  2. Dienstag JL. Hepatitis B virus infection. N Engl J Med 2008; 359: 1486-500.

  3. Seto WK, Lai CL, Yuen MF. Acute-on-chronic liver failure in chronic hepatitis B. J Gastroenterol Hepatol 2011.

  4. Chan HL, Tsang SW, Hui Y, Leung NW, Chan FK, Sung JJ. The role of lamivudine and predictors of mortality in severe flare-up of chronic hepatitis B with jaundice. J Viral Hepat 2002; 9: 424-8.

  5. Tsubota A, Arase Y, Suzuki Y, Suzuki F, Sezaki H, Hosaka T, Akuta N, et al. Lamivudine monotherapy for spontaneous severe acute exacerbation of chronic hepatitis B. J Gastroenterol Hepatol 2005; 20: 426-32.

  6. Chen J, Han JH, Liu C, Yu RH, Li FZ, Li QF, Gong GZ. Shortterm entecavir therapy of chronic severe hepatitis B. Hepatobiliary Pancreat Dis Int 2009; 8: 261-6.

  7. Tsang SW, Chan HL, Leung NW, Chau TN, Lai ST, Chan FK, Sung JJ. Lamivudine treatment for fulminant hepatic failure due to acute exacerbation of chronic hepatitis B infection. Aliment Pharmacol Ther 2001; 15: 1737-44.

  8. Tsubota A, Arase Y, Saitoh S, Kobayashi M, Suzuki Y, Suzuki F, Chayama K, et al. Lamivudine therapy for spontaneously occurring severe acute exacerbation in chronic hepatitis B virus infection: a preliminary study. Am J Gastroenterol 2001; 96: 557-62.

  9. Wong VW, Wong GL, Yiu KK, Chim AM, Chu SH, Chan HY, Sung JJ, et al. Entecavir treatment in patients with severe acute exacerbation of chronic hepatitis B. J Hepatol 2011; 54: 236-42.

  10. Tsubota A, Arase Y, Suzuki Y, Suzuki F, Hosaka T, Akuta N, Someya T, et al. Benefit of lamivudine therapy and factors associated with clinical outcome in spontaneous severe acute exacerbation of chronic hepatitis B virus infection. Intervirology 2004; 47: 335-41.

  11. Sarin SK, Kumar A, Almeida JA, Chawla YK, Fan ST, Garg H, de Silva HJ, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int 2009; 3: 269-82.

  12. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996; 17: 1-12.

  13. Hemingway H, Philipson P, Chen R, Fitzpatrick NK, Damant J, Shipley M, Abrams KR, et al. Evaluating the quality of research into a single prognostic biomarker: a systematic review and meta-analysis of 83 studies of C-reactive protein in stable coronary artery disease. PLoS Med 2010; 7: e1000286.

  14. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-34.

  15. Garg H, Sarin SK, Kumar M, Garg V, Sharma BC, Kumar A. Tenofovir improves the outcome in patients with spontaneous reactivation of hepatitis B presenting as acute-onchronic liver failure. Hepatology 2011; 53: 774-80.

  16. Hu JH, Wang HF, He WP, Liu XY, Du N, Huang K, Ding JB, et al. Lamivudine and entecavir significantly improved the prognosis of early-to-mid stage hepatitis B related acute on chronic liver failure. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2010; 24: 205-8.

  17. Chen T, He Y, Liu X, Yan Z, Wang K, Liu H, Zhang S, et al. Nucleos(t)ide analogues improve the short-term and longterm prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure. Clin Exp Med 2011.

  18. Cui YL, Yan F, Wang YB, Song XQ, Liu L, Lei XZ, Zheng MH, et al. Nucleos(t)ide analogue can improve the longterm prognosis of patients with hepatitis B virus infection- associated acute on chronic liver failure. Dig Dis Sci 2010; 55: 2373-80.

  19. Sun LJ, Yu JW, Zhao YH, Kang P, Li SC. Influential factors of prognosis in lamivudine treatment for patients with acute-on-chronic hepatitis B liver failure. J Gastroenterol Hepatol 2010; 25: 583-90.

  20. Wu YZ, Zhao FL, Zhang CZ, Li MH, Xie Y. Factors related to the outcome of patients with chronic severe hepatitis B and effectiveness of antivirus therapy. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2007; 21: 120-2.

  21. Lai CL, Shouval D, Lok AS, Chang TT, Cheinquer H, Goodman Z, DeHertogh D, et al. Entecavir versus lamivudine for patients with HBeAg-negative chronic hepatitis B. N Engl J Med 2006; 354: 1011-20.

  22. Chang TT, Gish RG, de Man R, Gadano A, Sollano J, Chao YC, Lok AS, et al. A comparison of entecavir and lamivudine for HBeAg-positive chronic hepatitis B. N Engl J Med 2006; 354: 1001-10.

  23. Olson JC, Kamath PS. Acute-on-chronic liver failure: concept, natural history, and prognosis. Curr Opin Crit Care 2011; 17: 165-9.

  24. Dai CY, Chuang WL, Hou NJ, Lee LP, Hsieh MY, Lin ZY, Chen SC, et al. Early mortality in Taiwanese lamivudinetreated patients with chronic hepatitis B-related decompensation: evaluation of the model for end-stage liver disease and index scoring systems as prognostic predictors. Clin Ther 2006; 28: 2081-92.

  25. Villeneuve JP, Condreay LD, Willems B, Pomier-Layrargues G, Fenyves D, Bilodeau M, Leduc R, et al. Lamivudine treatment for decompensated cirrhosis resulting from chronic hepatitis B. Hepatology 2000; 31: 207-10.




2020     |     www.medigraphic.com