title: Systematic review of the literature on comparative effectiveness of antiviral treatments for chronic hepatitis B infection.
abstract: OBJECTIVE
  To evaluate the comparative effectiveness of antiviral drugs in adults with chronic hepatitis B monoinfection for evidence-based decision-making.
  
  
  METHODS
  A systematic review of randomized controlled clinical trials (RCTs) published in English. Results after interferon and nucleos(t)ides analog therapies were synthesized with random-effects meta-analyses and number needed to treat (NNT).
  
  
  RESULTS
  Despite sustained improvements in selected biomarkers, no one drug regimen improved all intermediate outcomes. In 16 underpowered RCTs, drug treatments did not reduce mortality, liver cancer, or cirrhosis. Sustained HBV DNA clearance was achieved in one patient when two were treated with adefovir (NNT from 1 RCT=2 95%CI 1;2) or interferon alpha-2b (NNT from 2 RCTs=2 95%CI 2;4), 13 with lamivudine (NNT from 1 RCT=13 95%CI 7;1000), and 11 with peginterferon alpha-2a vs. lamivudine (NNT from 1 RCT=11 95%CI 7;25). Sustained HBeAg seroconversion was achieved in one patient when eight were treated with interferon alpha-2b (NNT from 2 RCTs=8 95%CI 5;33) or 10--with peginterferon alpha-2b vs. interferon alpha-2b (NNT from 1 RCT=10 95%CI 5;1000). Greater benefits and safety after entecavir vs. lamivudine or pegylated interferon alpha-2b vs. interferon alpha-2b require future investigation of clinical outcomes. Adverse events were common and more frequent after interferon. Treatment utilization for adverse effects is unknown.
  
  
  CONCLUSIONS
  Individual clinical decisions should rely on comparative effectiveness and absolute rates of intermediate outcomes and adverse events. Future research should clarify the relationship of intermediate and clinical outcomes and cost-effectiveness of drugs for evidence-based policy and clinical decisions.
authors.affiliation: Division of Health Policy and Management, Minnesota Evidence-based Practice Center, University of Minnesota School of Public Health, 420 Delaware Street SE, D330-5 Mayo (MMC 729), Minneapolis, MN 55455, USA. shaml005@umn.edu
authors.forename: Tatyana A
authors.initials: TA
authors.lastname: Shamliyan
authors.forename: James R
authors.initials: JR
authors.lastname: Johnson
authors.forename: Roderick
authors.initials: R
authors.lastname: MacDonald
authors.forename: Aasma
authors.initials: A
authors.lastname: Shaukat
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Yuan
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wilt
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000818:Animals; D000998:Antiviral Agents / Q000627:therapeutic use*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D063065:Organophosphonates / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D011994:Recombinant Proteins; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D063065:Organophosphonates; D011994:Recombinant Proteins; D019259:Lamivudine; C053001:adefovir; D000225:Adenine