title: The efficacy and safety of nucleos(t)ide analogues in the treatment of HBV-related acute-on-chronic liver failure: a meta-analysis.
abstract: OBJECTIVE
  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 metaanalysis of prospective and retrospective studies to examine the efficacy and safety of nucleos(t)ide analogues in treating HBV-related ACLF.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Shi
authors.initials: S
authors.lastname: Yu
authors.forename: He
authors.initials: H
authors.lastname: Jianqin
authors.forename: Wu
authors.initials: W
authors.lastname: Wei
authors.forename: Huang
authors.initials: H
authors.lastname: Jianrong
authors.forename: Yang
authors.initials: Y
authors.lastname: Yida
authors.forename: Sheng
authors.initials: S
authors.lastname: Jifang
authors.forename: Yu
authors.initials: Y
authors.lastname: Liang
authors.forename: Chen
authors.initials: C
authors.lastname: Zhi
authors.forename: Jia
authors.initials: J
authors.lastname: Hongyu
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D004279:DNA, Viral / Q000097:blood; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006515:Hepatitis B virus / Q000187:drug effects / Q000235:genetics / Q000254:growth & development; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D009705:Nucleosides / Q000009:adverse effects / Q000627:therapeutic use*; D009711:Nucleotides / Q000009:adverse effects / Q000627:therapeutic use*; D016017:Odds Ratio; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D009705:Nucleosides; D009711:Nucleotides