title: Comparison of the efficacy of tenofovir monotherapy versus tenofovir-based combination therapy in adefovir-experienced chronic hepatitis B patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  Chronic hepatitis B virus (HBV) infection remains a major public health problem worldwide. Tenofovir monotherapy or tenofovir-based combination therapy have achieved promising results in the treatment of chronic hepatitis B patients who failed adefovir therapy.
  
  
  OBJECTIVE
  The goal of this study was to assess the efficacy of tenofovir monotherapy compared with tenofovir-based combination therapy for treatment of adefovir-experienced chronic hepatitis B (CHB) patients.
  
  
  METHODS
  randomized and non-randomized control trials directly comparing tenofovir monotherapy and tenofovir-based combination therapy were searched in PUBMED, MEDLINE, EMBASE database up to April 30, 2015. The data were analyzed with Review Manager (v.5.3).
  
  
  RESULTS
  Seven articles (total of 478 patients) met entry criteria. The results found that the rates of undetectable hepatitis B virus DNA levels (64.7% vs. 68.5%, P = 0.58 for 24 weeks; 71.4% vs. 71.7%, P = 0.76 for 48 weeks; 71.6% vs. 73.0%, P = 0.92 for 96 weeks), alanine aminotransferase (ALT) normalization (72.6% vs. 69.2%, P = 0.46 for 48 weeks; 72.8% vs. 75.0%, P = 0.74 for 96 weeks) and hepatitis Be antigen loss (5.0% vs. 0, P = 0.43 for 48 weeks; 16.5% vs. 12.5%, P = 0.43 for 96 weeks) were not significantly different between the TDF alone and the TDF-based group. Moreover, the rate of adverse reactions was also not significantly different between the 2 groups (P = 0.06 for 96 weeks).
  
  
  CONCLUSIONS
  TDF monotherapy and TDF-based combination therapy are similarly effective and safe in adefovir-experienced CHB patients after 48 weeks and 96 weeks of antiviral therapy. Nevertheless, large scale randomized control trials should be carried out to elucidate the long-term outcome of TDF treatment.
authors.affiliation: Department of Genetics and Molecular Biology, School of Medicine, Xi'an Jiaotong UniversityXi'an 710061, Shaanxi, P. R. China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of EducationXi'an 710061, Shaanxi, P. R. China.
authors.forename: Huilian
authors.initials: H
authors.lastname: Wang
authors.affiliation: School of Mechanical Engineering, Xi'an Jiaotong University Xi'an 710049, Shaanxi, P. R. China.
authors.forename: Xi
authors.initials: X
authors.lastname: Lu
authors.affiliation: Department of Genetics and Molecular Biology, School of Medicine, Xi'an Jiaotong UniversityXi'an 710061, Shaanxi, P. R. China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of EducationXi'an 710061, Shaanxi, P. R. China.
authors.forename: Xudong
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Genetics and Molecular Biology, School of Medicine, Xi'an Jiaotong UniversityXi'an 710061, Shaanxi, P. R. China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of EducationXi'an 710061, Shaanxi, P. R. China.
authors.forename: Qilan
authors.initials: Q
authors.lastname: Ning
keywords: Chronic hepatitis B; adefovir failure; adefovir-resistant; tenofovir monotherapy; tenofovir-based combination therapy