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Tenofovir Versus Entecavir for the Treatment of Acute-on-Chronic Liver Failure due to Reactivation of Chronic Hepatitis B With Genotypes B and C.
Wan, Yue-Meng; Li, Yu-Hua; Xu, Zhi-Yuan; Wu, Hua-Mei; Xu, Ying; Wu, Xi-Nan; Yang, Jin-Hui.
Afiliación
  • Wan YM; Gastroenterology Department II or Hepatology Center, The 2nd Affiliated Hospital of Kunming Medical University.
  • Li YH; Public Health Institute of Kunming Medical University, Kunming City, Yunnan Province, China.
  • Xu ZY; Gastroenterology Department II or Hepatology Center, The 2nd Affiliated Hospital of Kunming Medical University.
  • Wu HM; Gastroenterology Department II or Hepatology Center, The 2nd Affiliated Hospital of Kunming Medical University.
  • Xu Y; Gastroenterology Department II or Hepatology Center, The 2nd Affiliated Hospital of Kunming Medical University.
  • Wu XN; Gastroenterology Department II or Hepatology Center, The 2nd Affiliated Hospital of Kunming Medical University.
  • Yang JH; Public Health Institute of Kunming Medical University, Kunming City, Yunnan Province, China.
J Clin Gastroenterol ; 53(4): e171-e177, 2019 04.
Article en En | MEDLINE | ID: mdl-29659382
ABSTRACT
BACKGROUND AND

AIMS:

Acute-on-chronic liver failure (ACLF) can be triggered by reactivation of chronic hepatitis B (CHB). Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) are now the most potent antiviral agents for CHB. This study aimed to compare the short-term safety and efficacy of TDF with ETV in the treatment of ACLF due to reactivation of CHB [hepatitis B virus (HBV)-ACLF]. PATIENTS AND

METHODS:

In total, 67 consecutive patients with HBV-ACLF were divided into TDF group (n=32) receiving daily TDF (300 mg/d) and ETV group (n=35) receiving daily ETV (0.5 mg/d). They were prospectively followed-up and the primary endpoint was overall survival at 3 months.

RESULTS:

At 2 weeks, the TDF group had significantly higher HBV-DNA reduction (P=0.003), lower HBV-DNA level (P=0.001), higher rate of HBV-DNA undetectbility (P=0.007), lower Child-Turcotte-Pugh (CTP; P=0.003), and model for end-stage liver disease (P=0.002) scores than the ETV group. At 3 months, HBV-DNA was undetectable in all survived patients; CTP (P=0.970) and model for end-stage liver disease (P=0.192) scores were comparable between the 2 groups, but markedly lower than at baseline (P<0.01); the TDF group had significantly higher cumulative survival rate than the ETV group (P=0.025). The white blood cell count (hazard ratio, 2.726; 95% confidence interval, 2.691-7.897; P=0.000), and HBV-DNA reduction (hazard ratio, 0.266; 95% confidence interval, 0.033-0.629; P=0.013) at 2 weeks were independent predictors for mortality. Both drugs were well tolerated.

CONCLUSIONS:

The short-term efficacy of TDF was superior to ETV for the treatment of HBV-ACLF. The white blood cell count and HBV-DNA reduction at 2 weeks were independent predictors for mortality at 3 months.
Asunto(s)

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Antivirales / Hepatitis B Crónica / Insuficiencia Hepática Crónica Agudizada / Tenofovir / Guanina Tipo de estudio: Prognostic_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Clin Gastroenterol Año: 2019 Tipo del documento: Article

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Antivirales / Hepatitis B Crónica / Insuficiencia Hepática Crónica Agudizada / Tenofovir / Guanina Tipo de estudio: Prognostic_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Clin Gastroenterol Año: 2019 Tipo del documento: Article