title: Entecavir versus Lamivudine therapy for patients with chronic hepatitis B-associated liver failure: a meta-analysis.
abstract: BACKGROUND
  Nucleoside analogues are recommended as antiviral treatments for patients with hepatitis B virus (HBV)-associated liver failure. Clinical data comparing entecavir (ETV) and lamivudine (LAM) are inconsistent in this setting.
  
  
  OBJECTIVE
  To compare the efficacy and safety of ETV and LAM in patients with chronic hepatitis B (CHB)-associated liver failure.
  
  
  METHODS
  A literature search was performed on articles published until January 2014 on therapy with ETV and LAM for patients with CHB-associated liver failure. Risk ratio (RR) and mean difference (MD) were used to measure the effects. Survival rate was the primary efficacy measure, while total bilirubin (TBIL), prothrombin activity (PTA) changes and HBV DNA negative change rates were secondary efficacy measures. A quantitative meta-analysis was performed to compare the efficacy of the two drugs. Safety of ETV and LAM was observed.
  
  
  RESULTS
  Four randomized controlled trials and nine retrospective cohort studies comprising a total of 1549 patients were selected. Overall analysis revealed comparable survival rates between patients received ETV and those received LAM (4 weeks: RR = 1.03, 95%CI [0.89, 1.18], P = 0.73; 8 weeks: RR = 0.98, 95% CI [0.85, 1.14], P = 0.84; 12 weeks: RR = 0.98, 95% CI [0.90, 1.08], P = 0.70; 24 weeks: RR = 1.02, 95% CI [0.94, 1.10], P = 0.66). After 24 weeks of treatment, patients treated with ETV had a significantly lower TBIL levels (MD = -37.34, 95% CI [-63.57, -11.11], P = 0.005), higher PTA levels (MD = 11.10, 95% CI [2.47, 19.73], P = 0.01) and higher HBV DNA negative rates (RR = 2.76, 95% CI [1.69, 4.51], P < 0.0001) than those treated with LAM. In addition, no drug related adverse effects were observed in the two treatment groups.
  
  
  CONCLUSIONS
  ETV and LAM treatments had similar effects to improve 24 weeks survival rate of patients with CHB-associated liver failure, but ETV was associated with greater clinical improvement. Both drugs were tolerated well during the treatment. It is suggested to perform further studies to verify the results.
authors.affiliation: Division of Liver Disease, Jinan Infectious Disease Hospital, Shandong University, Jinan, China.
authors.forename: Xiaoguo
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Division of Liver Disease, Qianfoshan Hospital, Shandong University, Jinan, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: An
authors.affiliation: Division of Liver Disease, Jinan Infectious Disease Hospital, Shandong University, Jinan, China.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Jiang
authors.affiliation: Division of Liver Disease, Jinan Infectious Disease Hospital, Shandong University, Jinan, China.
authors.forename: Minling
authors.initials: M
authors.lastname: Xu
authors.affiliation: Division of Liver Disease, Jinan Infectious Disease Hospital, Shandong University, Jinan, China.
authors.forename: Linlin
authors.initials: L
authors.lastname: Xu
authors.affiliation: Division of Liver Disease, Jinan Infectious Disease Hospital, Shandong University, Jinan, China.
authors.forename: Shijun
authors.initials: S
authors.lastname: Chen
authors.affiliation: Mitchell Cancer Institute, University of South Alabama, Mobile, USA.
authors.forename: Yaguang
authors.initials: Y
authors.lastname: Xi
keywords: Entecavir; Hepatitis B; LAM; Lamivudine; Liver Failure