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Research Paper|Volume 13, Issue 5|pp 7147—7165

No difference in hepatocellular carcinoma risk in chronic hepatitis B patients treated with tenofovir vs entecavir: evidence from an updated meta-analysis

Jie Yuan1, Yang Peng2, Fa-Bao Hao3, Ya-Qin Wang4, Chun-Rui Wang5, Guo-Chao Zhong6,7
  • 1Department of Surgery, Maternal and Child Health Hospital of Yongchuan, Chongqing, China
  • 2Department of Geriatrics, The Fifth People’s Hospital of Chengdu, Chengdu, China
  • 3Department of Neurosurgery, Qingdao Women and Children’s Hospital, Qingdao University, Qingdao, China
  • 4Department of Children Healthcare, Maternal and Child Health Hospital of Yongchuan, Chongqing, China
  • 5Department of Infectious Diseases, Institute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
  • 6Graduate School, Chongqing Medical University, Chongqing, China
  • 7Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
Received: October 8, 2020Accepted: January 4, 2021Published: February 26, 2021
https://doi.org/10.18632/aging.202573

Copyright: © 2021 Yuan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Whether tenofovir disoproxil fumarate (TDF) is superior to entecavir in reducing hepatocellular carcinoma (HCC) risk among treatment-naïve chronic hepatitis B (CHB) patients remains controversial. We aimed to clarify this controversy. Several databases, including PubMed and Embase, were retrieved through November 2020. Cohort studies comparing the effectiveness of TDF and entecavir in reducing HCC incidence among treatment-naïve CHB patients were included if they reported multivariable-adjusted or propensity-score-matched risk estimates. A random-effects model was used to pool hazard ratios (HRs). Thirteen cohort studies, involving 4097 HCC cases and 80202 CHB patients, were included. Multivariable-adjusted meta-analysis revealed no significant difference in HCC incidence between TDF and entecavir groups (HR 0.86, 95% confidence interval 0.72–1.04), which was consistent with propensity-score-matched meta-analysis (HR 0.83, 95% confidence interval 0.66–1.03). Subgroup analysis showed that the observed similarity of TDF to entecavir for HCC prevention persisted in studies with follow-up length of ≥4 years but not in those with follow-up length of <4 years (Pinteraction<0.01). In conclusion, TDF is similar to entecavir in reducing HCC incidence among treatment-naïve CHB patients. Heterogeneous results of included studies may result from their disparity in follow-up length. Our findings should be treated with caution and need to be further confirmed.