Comparative efficacy of oral nucleoside or nucleotide analog monotherapy used in chronic hepatitis B: a mixed-treatment comparison meta-analysis.
OBJECTIVE
To compare the efficacy of nucleoside or nucleotide analog monotherapy for the treatment of chronic hepatitis virus B (HBV) with adefovir dipivoxil, entecavir, lamivudine, telbivudine, and tenofovir disoproxil fumarate.


METHODS
Mixed-treatment comparison meta-analysis of nine randomized controlled clinical trials.


METHODS
A total of 3972 adults with a diagnosis of chronic hepatitis B.


RESULTS
A systematic review was conducted to search for randomized clinical trials that evaluated the efficacy of nucleoside or nucleotide analogs used as monotherapy. The evaluated outcomes were reduction of HBV DNA levels, normalization of alanine aminotransferase levels, and seroconversion of hepatitis B e antigen (HBeAg). A mixed-treatment comparison was conducted to compare the odds ratios among the treatments and to rank the therapies to determine the optimal treatment option. Tenofovir had the best results among the nucleoside or nucleotide analogs for the three evaluated efficacy outcomes in both HBeAg-positive and -negative patients.


CONCLUSIONS
Tenofovir has the highest probability of reducing HBV DNA, normalizing alanine aminotransferase levels and inducing HBeAg seroconversion after 1 year of treatment. An efficacy comparison of therapies is an important tool to guide clinicians in selecting the optimal treatment option.
Pharmacy Department, Pharmacy Practice Research Group, Federal University of Paraná, Brasil.
Astrid
A
Wiens
Luana
L
Lenzi
Rafael
R
Venson
Cassyano J
CJ
Correr
Inajara
I
Rotta
Maria L
ML
Pedroso
Roberto
R
Pontarolo
D000284:Administration, Oral; D000998:Antiviral Agents / Q000008:administration & dosage*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D009705:Nucleosides / Q000008:administration & dosage*; D009711:Nucleotides / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016896:Treatment Outcome
D000998:Antiviral Agents; D009705:Nucleosides; D009711:Nucleotides