Mortality in patients with chronic hepatitis B treated with tenofovir or entecavir: A multinational study

J Gastroenterol Hepatol. 2024 Jun;39(6):1190-1197. doi: 10.1111/jgh.16537. Epub 2024 Mar 13.

Abstract

Background and aim: The benefits of entecavir (ETV) versus tenofovir disoproxil fumarate (TDF) in reducing the development of chronic hepatitis B (CHB)-related hepatocellular carcinoma remain controversial. Whether mortality rates differ between patients with CHB treated with ETV and those treated with TDF is unclear.

Methods: A total of 2542 patients with CHB treated with either ETV or TDF were recruited from a multinational cohort. A 1:1 propensity score matching was performed to balance the differences in baseline characteristics between the two patient groups. We aimed to compare the all-cause, liver-related, and non-liver-related mortality between patients receiving ETV and those receiving TDF.

Results: The annual incidence of all-cause mortality in the entire cohort was 1.0/100 person-years (follow-up, 15 757.5 person-years). Patients who received TDF were younger and had a higher body mass index, platelet count, hepatitis B virus deoxyribonucleic acid levels, and proportion of hepatitis B e-antigen seropositivity than those who received ETV. The factors associated with all-cause mortality were fibrosis-4 index > 6.5 (hazard ratio [HR]/confidence interval [CI]: 3.13/2.15-4.54, P < 0.001), age per year increase (HR/CI: 1.05/1.04-1.07, P < 0.001), alanine aminotransferase level per U/L increase (HR/CI: 0.997/0.996-0.999, P = 0.003), and γ-glutamyl transferase level per U/L increase (HR/CI: 1.002/1.001-1.003, P < 0.001). No significant difference in all-cause mortality was observed between the ETV and TDF groups (log-rank test, P = 0.69). After propensity score matching, no significant differences in all-cause, liver-related, or non-liver-related mortality were observed between the two groups.

Conclusions: Long-term outcomes of all-cause mortality and liver-related and non-liver-related mortality did not differ between patients treated with ETV and those receiving TDF.

Keywords: ETV; NA; TDF; antigen; antiviral; cohort; fibrosis; hepatocellular carcinoma; liver; prognosis.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Antiviral Agents* / therapeutic use
  • Carcinoma, Hepatocellular / mortality
  • Cohort Studies
  • Female
  • Guanine* / analogs & derivatives
  • Guanine* / therapeutic use
  • Hepatitis B, Chronic* / drug therapy
  • Hepatitis B, Chronic* / mortality
  • Humans
  • Liver Neoplasms / mortality
  • Male
  • Middle Aged
  • Propensity Score
  • Tenofovir* / therapeutic use

Substances

  • entecavir
  • Tenofovir
  • Guanine
  • Antiviral Agents