For HCC risk, entecavir or tenofovir?

  • Tseng CH & al.
  • Lancet Gastroenterol Hepatol
  • 29 Sep 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Entecavir and tenofovir have similar efficacy in reducing the risk for hepatocellular carcinoma (HCC).

Why this matters

  • The choice between entecavir and tenofovir should be made based on cost and tolerability rather than efficacy in prevention of HCC.

Study design

  • Meta-analysis of 31 studies (N=119,053).
  • Funding: E-DA Hospital.

Key results

  • 5-year incidence of HCC was 5.97% for entecavir (28 studies, n=86,855) and 3.06% for tenofovir (13 studies, n=28,946; P<.0001>
  • In 8 studies that conducted propensity-score matching, the 5-year cumulative incidence of HCC was 3.44% for entecavir (n=19,702) and 3.39% for tenofovir (n=16,266; P=.87).
  • A meta-analysis of 14 comparative studies found no significant difference between tenofovir and entecavir with respect to HCC risk (HR, 0.88; P=.20).
    • The studies had significant heterogeneity (I2=56.4%; P=.0038).
  • A subanalysis of hospital-based cohorts showed no difference between the 2 regimens (adjusted HR, 1.03; 95% CI, 0.88-1.21; I2=0%).
  • Tenofovir was associated with lower risk for HCC among studies that used administrative databases (HR, 0.67; 95% CI, 0.59-0.76; I2=0%).

Limitations

  • All studies were observational.
  • Many of the studies involved participants of Asian ancestry.