title: The efficacy and safety of entecavir in patients with chronic hepatitis B- associated liver failure: a meta-analysis.
abstract: BACKGROUND
  The effectiveness of nucleoside analogue (NA) treatment in patients with chronic hepatitis B (CHB) -associated liver failure is still controversial. Severe lactic acidosis has been reported during entecavir (ETV) treatment in patients with impaired liver function.
  
  
  OBJECTIVE
  To investigate the rescuing efficacy and safety of ETV in patients with CHB-associated liver failure.
  
  
  METHODS
  A literature search was carried out to collect articles dated up to December, 2013 on ETV therapy for patients with CHB-associated liver failure. Risk ratio (RR) and mean difference (MD) were used to measure the effects. Survival rate was used as the primary efficacy measure. The safety of ETV was assessed.
  
  
  RESULTS
  Six randomized controlled trials were selected. The overall analysis revealed ETV significantly improved survival at 4 weeks (RR = 1.35; 95% CI [1.16, 1.57]; p < 0.0001), 8 weeks (RR = 1.33; 95% CI [1.07, 1.64]; p = 0.009), 12 weeks (RR = 1.68; 95% CI [1.24, 2.28]; p = 0.0008). Pooled data also showed beneficial effects of antiviral therapy compared with control for HBV DNA negative change (RR = 5.35; 95% CI [2.06, 13.88]; p = 0.0006), TBIL and PTA improvement (TBIL: MD = -69.36; 95% CI [-134.37, -4.36]; p = 0.04. PTA: MD = 16.26; 95% CI [8.59, 23.94]; p < 0.0001). No adverse effect was identified in the examined studies.
  
  
  CONCLUSIONS
  Our results showed that antiviral therapy with ETV improved the short-term survival of patients with CHB-associated liver failure. In addition, ETV was well tolerated during the treatment period. Further studies are still needed to strengthen these results.
authors: Division of Liver Disease, Jinan Infectious Disease Hospital, Shandong University, 22029# JingShi Road, Jinan 250021, China.
authors: Xiaoguo
authors: X
authors: Zhang
authors: Shandong University School of Medicine, Jinan 250021, China.
authors: Lu
authors: L
authors: Liu
authors: Division of Liver Disease, Jinan Infectious Disease Hospital, Shandong University, 22029# JingShi Road, Jinan 250021, China.
authors: Meng
authors: M
authors: Zhang
authors: Division of Liver Disease, Jinan Infectious Disease Hospital, Shandong University, 22029# JingShi Road, Jinan 250021, China.
authors: Shuchun
authors: S
authors: Gao
authors: Division of Liver Disease, Jinan Infectious Disease Hospital, Shandong University, 22029# JingShi Road, Jinan 250021, China.
authors: Yizhen
authors: Y
authors: Du
authors: Division of Liver Disease, Qianfoshan Hospital, Shandong University, 16766# JingShi Road, Jinan 250014, China.
authors: Yong
authors: Y
authors: An
authors: Division of Liver Disease, Jinan Infectious Disease Hospital, Shandong University, 22029# JingShi Road, Jinan 250021, China.
authors: Shijun
authors: S
authors: Chen
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005260:Female; D006147:Guanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis / Q000401:mortality / Q000821:virology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; C413685:entecavir; D006147:Guanine