title: Comparative effectiveness of nucleos(t)ide analogues in chronic hepatitis B patients undergoing cytotoxic chemotherapy.
abstract: BACKGROUND
  Comparative effectiveness of different nucleos(t)ide analogues for preventing hepatitis B virus reactivation induced by cytotoxic chemotherapy has not been elucidated. The prophylactic drug of choice remains controversial.
  
  
  OBJECTIVE
  Our objective was to compare the effectiveness of tenofovir, telbivudine and entecavir with lamivudine in preventing the reactivation of hepatitis B virus caused by chemotherapy.
  
  
  METHODS
  This retrospective cohort study consecutively screened all patients who were positive for hepatitis B virus surface antigen and received chemotherapy for malignant diseases in a teaching hospital in Taiwan. Eligible patients were grouped according to whether they received nucleos(t)ide analogues before (prophylactic group) or during chemotherapy (historical control). Those who received antiviral prophylaxis were further classified by the medications that included lamivudine, telbivudine, entecavir and tenofovir. The incidence of hepatitis, liver decompensation and interruption of chemotherapy were audited.
  
  
  RESULTS
  A total of 212 consecutive patients were enrolled into analysis. Those who prophylactically used nucleos(t)ide analogues (n = 177) had significantly lower rates of liver decompensation (0.6% vs 20%, P < 0.01), interruption of chemotherapy (0% vs 40%, P < 0.01) and incidence of hepatitis (4.5% vs 100%, P < 0.01), as compared with their historical control (n = 35). In the prophylactic group, there was no difference among tenofovir, telbivudine, entecavir and lamivudine users in the incidence of hepatitis, liver decompensation and interruption of chemotherapy.
  
  
  CONCLUSIONS
  Lamivudine, telbivudine, entecavir and tenofovir are all effective as the prophylactic antiviral therapy to prevent reactivation of hepatitis B induced by chemotherapy.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung City, Taiwan.
authors.forename: Chao-Ming
authors.initials: CM
authors.lastname: Tseng
authors.affiliation: Department of Medical Imaging and Radiological Sciences, Kaohsiung City, Taiwan.
authors.forename: Tai-Been
authors.initials: TB
authors.lastname: Chen
authors.affiliation: Center for Database Research, E-Da hospital, Kaohsiung City, Taiwan.|School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan.|Graduate Institute of Clinical Medicine, China Medical University, Taichung City, Taiwan.
authors.forename: Yao-Chun
authors.initials: YC
authors.lastname: Hsu
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung City, Taiwan.
authors.forename: Chi-Yang
authors.initials: CY
authors.lastname: Chang
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung City, Taiwan.|School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Jaw-Town
authors.initials: JT
authors.lastname: Lin
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung City, Taiwan.|Division of Gastroenterology, Tainan Municipal Hospital, Tainan City, Taiwan.
authors.forename: Lein-Ray
authors.initials: LR
authors.lastname: Mo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000998:Antiviral Agents / Q000627:therapeutic use*; D003603:Cytotoxins / Q000008:administration & dosage; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006515:Hepatitis B virus / Q000187:drug effects* / Q000502:physiology; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D012189:Retrospective Studies; D000077712:Telbivudine; D000068698:Tenofovir / Q000627:therapeutic use; D013936:Thymidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014775:Virus Activation / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents; D003603:Cytotoxins; D000077712:Telbivudine; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; D000068698:Tenofovir; D013936:Thymidine
keywords: antiviral therapy; chemotherapy; comparative effectiveness; hepatitis B virus