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Review
. 2016:2016:3435965.
doi: 10.1155/2016/3435965. Epub 2016 Sep 8.

Antiviral Therapy in Lamivudine-Resistant Chronic Hepatitis B Patients: A Systematic Review and Network Meta-Analysis

Hui-Lian Wang  1 , Xi Lu  2 , Xudong Yang  1 , Nan Xu  3
Affiliations
Review

Antiviral Therapy in Lamivudine-Resistant Chronic Hepatitis B Patients: A Systematic Review and Network Meta-Analysis

Hui-Lian Wang et al. Gastroenterol Res Pract. 2016.

Abstract

The relative efficacy of different strategies for chronic hepatitis B (CHB) patients with lamivudine resistance (LAM-R) has not yet been systematically studied. Clinical trials were searched in PUBMED, MEDLINE, EMBASE, and CNKI databases up to February 15, 2016. Nine trials including 764 patients met the entry criteria. In direct meta-analysis, TDF showed a stronger antiviral effect than any one of ETV, LAM/ADV, and ADV against LAM-R hepatitis B virus. LAM/ADV therapy was superior to ADV in suppressing viral replication. ETV achieved similar rate of HBV DNA undetectable compared to ADV or LAM/ADV. In network meta-analysis, TDF had higher rates of HBV DNA undetectable compared to ETV (OR, 24.69; 95% CrI: 5.36-113.66), ADV (OR, 37.28; 95% CrI: 9.73-142.92), or LAM/ADV (OR, 21.05; 95% CrI: 5.70-77.80). However, among ETV, ADV, and LAM/ADV, no drug was clearly superior to others in HBV DNA undetectable rate. Moreover, no significant difference in the rate of ALT normalization or HBeAg loss was observed compared the four rescue strategies with each other. TDF appears to be a more effective rescue therapy than LAM/ADV, ETV, or ADV. LAM plus ADV therapy was a better treatment option than ETV or ADV alone for patients with LAM-R.

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Figures

Figure 1
Figure 1
Forest plot of direct meta-analysis of undetectable HBV DNA rate. (a) 24 weeks; (b) 48 weeks; (c) 96 weeks.
Figure 2
Figure 2
Forest plot of direct meta-analysis of viral breakthrough and genotypic resistance. (a) 48 weeks; (b) 96 weeks.
Figure 3
Figure 3
Rank probability and network plot of 48 weeks of undetectable HBV DNA rate. (a) rank probability. Different color indicates different rank showed in the picture; for example, the lightest color means rank 4. The highest bar in the chart of one intervention represents its rank probability. Rank 1 means the best efficiency, and rank 4 means the worst. The bar which means rank 1 in TDF treatment group is the highest bar; therefore, TDF treatment had the highest probability for achieving HBV DNA undetectable after 48-week treatment; (b) network plot. The node size indicates the sample size in the treatment group that the node stands for; the thickness of the link represents the sample size of the direct comparisons.
See this image and copyright information in PMC

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