Tenofovir Versus Entecavir for Hepatocellular Carcinoma Prevention in an International Consortium of Chronic Hepatitis B

Yao Chun Hsu, Grace Lai Hung Wong, Chien Hung Chen, Cheng Yuan Peng, Ming Lun Yeh, Ka Shing Cheung, Hidenori Toyoda, Chung Feng Huang, Huy Trinh, Qing Xie, Masaru Enomoto, Li Liu, Satoshi Yasuda, Yasuhito Tanaka, Ritsuzo Kozuka, Pei Chien Tsai, Yen Tsung Huang, Christopher Wong, Rui Huang, Tyng Yuan JangJoseph Hoang, Hwai I. Yang, Jiayi Li, Dong Hyun Lee, Hirokazu Takahashi, Jian Q. Zhang, Eiichi Ogawa, Changqing Zhao, Chenghai Liu, Norihiro Furusyo, Yuichiro Eguchi, Clifford Wong, Chao Wu, Takashi Kumada, Man Fung Yuen, Ming Lung Yu, Mindie H. Nguyen

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10 Citations (Scopus)

Abstract

INTRODUCTION: It is unclear whether entecavir (ETV) and tenofovir disoproxil fumarate (TDF) differ in their effectiveness for preventing hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). METHODS: This retrospective cohort study analyzed an international consortium that encompassed 19 centers from 6 countries or regions composed of previously untreated CHB patients then treated with either ETV or TDF monotherapy. Those who developed HCC before antiviral treatment or within 1 year of therapy were excluded. The association between antiviral regimen and HCC risk was evaluated using competing-risk survival regression. We also applied propensity score matching (PSM) to 1:1 balance the 2 treatment cohorts. A total of 5,537 patients were eligible (n = 4,837 received ETV and n = 700 received TDF) and observed for HCC occurrence until December 23, 2018. Before PSM, the TDF cohort was significantly younger and had generally less advanced diseases. RESULTS: In the unadjusted analysis, TDF was associated with a lower risk of HCC (subdistribution hazard ratio [SHR], 0.45; 95% confidence interval [CI], 0.26-0.79; P = 0.005). The multivariable analysis, however, found that the association between TDF and HCC no longer existed (SHR, 0.81; 95% CI, 0.42-1.56; P = 0.52) after adjustment for age, sex, country, albumin, platelet, α-fetoprotein, cirrhosis, and diabetes mellitus. Furthermore, the PSM analysis (n = 1,040) found no between-cohort differences in HCC incidences (P = 0.51) and no association between regimens (TDF or ETV) and HCC risk in the multivariable-adjusted analysis (adjusted SHR, 0.89; 95% CI, 0.41-1.92; P = 0.77). DISCUSSION: TDF and ETV did not significantly differ in the prevention of HCC in patients with CHB.

Original languageEnglish
Pages (from-to)271-280
Number of pages10
JournalThe American journal of gastroenterology
Volume115
Issue number2
DOIs
Publication statusPublished - Feb 1 2020

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

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    Hsu, Y. C., Wong, G. L. H., Chen, C. H., Peng, C. Y., Yeh, M. L., Cheung, K. S., Toyoda, H., Huang, C. F., Trinh, H., Xie, Q., Enomoto, M., Liu, L., Yasuda, S., Tanaka, Y., Kozuka, R., Tsai, P. C., Huang, Y. T., Wong, C., Huang, R., ... Nguyen, M. H. (2020). Tenofovir Versus Entecavir for Hepatocellular Carcinoma Prevention in an International Consortium of Chronic Hepatitis B. The American journal of gastroenterology, 115(2), 271-280. https://doi.org/10.14309/ajg.0000000000000428