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Meta-analysis Finds Tenofovir and Entecavir Are Most Effective Antiviral Drugs for Chronic Hepatitis B

SUMMARY: The nucleotide analog tenofovir (Viread, also in the Truvada combination pill) and the nucleoside analog entecavir (Baraclude) demonstrated the most potent activity against hepatitis B virus (HBV) and its consequences in HBeAg positive patients during the first year of treatment, according to a systematic review and meta-analysis published in the June 20, 2010 advance online edition of Gastroenterology.

By Liz Highleyman

Gloria Woo from the University of Toronto and colleagues aimed to determine which approved antiviral drugs were the most effective therapies for chronic hepatitis B, focusing on relative efficacy during the first year of treatment.

The researchers searched medical publication databases for English-language reports of randomized controlled trials looking at the first 12 months of therapy in hepatitis B "e" antigen (HBeAg) positive or HBeAg negative chronic hepatitis B patients published before October 31, 2009.

The analysis included trials evaluating the oral agents lamivudine (Epivir-HBV), adefovir (Hepsera), telbivudine (Tyzeka), entecavir, and tenofovir, as well as injected pegylated interferon (Pegasys or PegIntron) -- both as monotherapy and in combination regimens -- for treatment-naive individuals.

Results

In studies of HBeAg positive patients, tenofovir was most effective at producing the following outcomes:
 
Undetectable HBV DNA viral load (predicted probability 88%);
Alanine aminotransferase (ALT) normalization (66%);
HBeAg seroconversion (20%);
Hepatitis B surface antigen (HBsAg) loss (5%).
Tenofovir ranked third for histological improvement of the liver, e.g., regression of fibrosis (53%).
Entecavir was most effective at improving liver histology (56%), second at producing undetectable HBV DNA (61%) and ALT normalization (70%), and third for HBsAg loss (1%).
In studies of HBeAg negative patients, tenofovir was most effective at producing undetectable HBV DNA (94%) and improving liver histology (65%), and ranked second for ALT normalization (73%).

Based on these findings, the study authors concluded, "In the first year of treatment for chronic hepatitis B, tenofovir and entecavir are the most potent oral antiviral agents for HBeAg positive patients; tenofovir is most effective for HBeAg-negative patients."

Investigator affiliations: Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada; Departments of Medicine and Health Policy, Management and Evaluation, and Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; University Health Network, Toronto General Research Institute and Clinical Studies Resource Centre Toronto Western Research Institute, Toronto, Ontario, Canada.

8/24/10

Reference
G Woo, G Tomlinson, Y Nishikawa, and others. Tenofovir and Entecavir Are the Most Effective Antiviral Agents for Chronic Hepatitis B: A Systematic Review and Bayesian Meta-Analyses. Gastroenterology (Abstract). June 20, 2010 (Epub ahead of print).


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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FDA-approved Therapies for Chronic HBV Infection
Baraclude  (entecavir)
Epivir-HBV
  (lamivudine; 3TC)
Hepsera
  (adefovir dipivoxil)
Intron A  (interferon alfa-2b)
Pegasys  (peginterferon alfa-2a)
Viread  (tenofovir)
Tyzeka   (telbivudine)

Experimental Treatments



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