Antiviral therapy for chronic hepatitis B viral infection in adults

A systematic review and meta-analysis

Anna S F Lok, Brian J. Mcmahon, Robert S. Brown, John B. Wong, Ahmed T. Ahmed, Wigdan Farah, Jehad Almasri, Fares Alahdab, Khalid Benkhadra, Mohamed A. Mouchli, Siddharth Singh, Essa A. Mohamed, Abd Moain Abu Dabrh, Larry J. Prokop, Zhen Wang, Mohammad H Murad, Khaled Mohammed

Research output: Contribution to journalArticle

152 Citations (Scopus)

Abstract

Chronic hepatitis B viral (HBV) infection remains a significant global health problem. Evidence-based guidelines are needed to help providers determine when treatment should be initiated, which medication is most appropriate, and when treatment can safely be stopped. The American Association for the Study of Liver Diseases HBV guideline methodology and writing committees developed a protocol a priori for this systematic review. We searched multiple databases for randomized controlled trials and controlled observational studies that enrolled adults ≥18 years old diagnosed with chronic HBV infection who received antiviral therapy. Data extraction was done by pairs of independent reviewers. We included 73 studies, of which 59 (15 randomized controlled trials and 44 observational studies) reported clinical outcomes. Moderate-quality evidence supported the effectiveness of antiviral therapy in patients with immune active chronic HBV infection in reducing the risk of cirrhosis, decompensated liver disease, and hepatocellular carcinoma. In immune tolerant patients, moderate-quality evidence supports improved intermediate outcomes with antiviral therapy. Only very low-quality evidence informed the questions about discontinuing versus continuing antiviral therapy in hepatitis B e antigen-positive patients who seroconverted from hepatitis B e antigen to hepatitis B e antibody and about the safety of entecavir versus tenofovir. Noncomparative and indirect evidence was available for questions about stopping versus continuing antiviral therapy in hepatitis B e antigen-negative patients, monotherapy versus adding a second agent in patients with persistent viremia during treatment, and the effectiveness of antivirals in compensated cirrhosis with low-level viremia. Conclusion: Most of the current literature focuses on the immune active phases of chronic HBV infection; decision-making in other commonly encountered and challenging clinical settings depends on indirect evidence.

Original languageEnglish (US)
Pages (from-to)284-306
Number of pages23
JournalHepatology
Volume63
Issue number1
DOIs
StatePublished - Jan 1 2016

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Chronic Hepatitis B
Virus Diseases
Antiviral Agents
Meta-Analysis
Hepatitis B e Antigens
Tenofovir
Viremia
Therapeutics
Observational Studies
Fibrosis
Randomized Controlled Trials
Guidelines
Hepatitis B Antibodies
Proxy
Hepatitis B
Liver Diseases
Hepatocellular Carcinoma
Decision Making
Databases
Safety

ASJC Scopus subject areas

  • Hepatology

Cite this

Lok, A. S. F., Mcmahon, B. J., Brown, R. S., Wong, J. B., Ahmed, A. T., Farah, W., ... Mohammed, K. (2016). Antiviral therapy for chronic hepatitis B viral infection in adults: A systematic review and meta-analysis. Hepatology, 63(1), 284-306. https://doi.org/10.1002/hep.28280

Antiviral therapy for chronic hepatitis B viral infection in adults : A systematic review and meta-analysis. / Lok, Anna S F; Mcmahon, Brian J.; Brown, Robert S.; Wong, John B.; Ahmed, Ahmed T.; Farah, Wigdan; Almasri, Jehad; Alahdab, Fares; Benkhadra, Khalid; Mouchli, Mohamed A.; Singh, Siddharth; Mohamed, Essa A.; Abu Dabrh, Abd Moain; Prokop, Larry J.; Wang, Zhen; Murad, Mohammad H; Mohammed, Khaled.

In: Hepatology, Vol. 63, No. 1, 01.01.2016, p. 284-306.

Research output: Contribution to journalArticle

Lok, ASF, Mcmahon, BJ, Brown, RS, Wong, JB, Ahmed, AT, Farah, W, Almasri, J, Alahdab, F, Benkhadra, K, Mouchli, MA, Singh, S, Mohamed, EA, Abu Dabrh, AM, Prokop, LJ, Wang, Z, Murad, MH & Mohammed, K 2016, 'Antiviral therapy for chronic hepatitis B viral infection in adults: A systematic review and meta-analysis', Hepatology, vol. 63, no. 1, pp. 284-306. https://doi.org/10.1002/hep.28280
Lok, Anna S F ; Mcmahon, Brian J. ; Brown, Robert S. ; Wong, John B. ; Ahmed, Ahmed T. ; Farah, Wigdan ; Almasri, Jehad ; Alahdab, Fares ; Benkhadra, Khalid ; Mouchli, Mohamed A. ; Singh, Siddharth ; Mohamed, Essa A. ; Abu Dabrh, Abd Moain ; Prokop, Larry J. ; Wang, Zhen ; Murad, Mohammad H ; Mohammed, Khaled. / Antiviral therapy for chronic hepatitis B viral infection in adults : A systematic review and meta-analysis. In: Hepatology. 2016 ; Vol. 63, No. 1. pp. 284-306.
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abstract = "Chronic hepatitis B viral (HBV) infection remains a significant global health problem. Evidence-based guidelines are needed to help providers determine when treatment should be initiated, which medication is most appropriate, and when treatment can safely be stopped. The American Association for the Study of Liver Diseases HBV guideline methodology and writing committees developed a protocol a priori for this systematic review. We searched multiple databases for randomized controlled trials and controlled observational studies that enrolled adults ≥18 years old diagnosed with chronic HBV infection who received antiviral therapy. Data extraction was done by pairs of independent reviewers. We included 73 studies, of which 59 (15 randomized controlled trials and 44 observational studies) reported clinical outcomes. Moderate-quality evidence supported the effectiveness of antiviral therapy in patients with immune active chronic HBV infection in reducing the risk of cirrhosis, decompensated liver disease, and hepatocellular carcinoma. In immune tolerant patients, moderate-quality evidence supports improved intermediate outcomes with antiviral therapy. Only very low-quality evidence informed the questions about discontinuing versus continuing antiviral therapy in hepatitis B e antigen-positive patients who seroconverted from hepatitis B e antigen to hepatitis B e antibody and about the safety of entecavir versus tenofovir. Noncomparative and indirect evidence was available for questions about stopping versus continuing antiviral therapy in hepatitis B e antigen-negative patients, monotherapy versus adding a second agent in patients with persistent viremia during treatment, and the effectiveness of antivirals in compensated cirrhosis with low-level viremia. Conclusion: Most of the current literature focuses on the immune active phases of chronic HBV infection; decision-making in other commonly encountered and challenging clinical settings depends on indirect evidence.",
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