A comparative network meta-analysis of standard of care treatments in treatment-naive chronic hepatitis B patients

Urbano Sbarigia, Talitha Vincken*, Peter Wigfield, Mahmoud Hashim, Bart Heeg, Maarten Postma

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Abstract

Objective:Published network meta-analyses of chronic hepatitis B (CHB) treatments are either out-of-date or excluded key treatments. Therefore, we aimed to comprehensively update the efficacy evidence for the following end points: Hepatitis B surface antigen (HBsAg) loss, hepatitis B early antigen (HBeAg) seroconversion and hepatitis B virus DNA (HBV DNA) suppression.Materials & methods:Approved treatments in CHB and their combinations were evaluated. A systematic literature review was conducted to identify all randomized controlled trials in treatment-naive CHB patients. Included studies reported at least one of the end points of interest. A frequentist probability network meta-analysis was performed for each end point. The choice of fixed effect or random-effect model was based on the I-square statistic, a measure of variation in study outcomes between studies. The analyses were performed separately for HBeAg-positive and HBeAg-negative patients. For the primary analyses, end points measured 48 +/- 4 weeks after treatment initiation were considered.Results:A total of 47 randomized controlled trials (13,826 patients), covering 23 unique treatment regimens, were included: a total of 29 reported HBsAg loss, 36 reported HBeAg seroconversion and 37 reported HBV DNA suppression. For both HBsAg loss and HBeAg seroconversion, pegylated interferon-based regimens were the most effective strategy in both HBeAg-positive and HBeAg-negative patients. On the other hand, for HBV DNA suppression, nucleosides-based regimens were the most effective strategy in both HBeAg-positive and HBeAg-negative patients.Conclusion:Our findings confirm available evidence around the comparative efficacy of available CHB treatments. Therefore, they can be used to update relevant cost-effectiveness analyses and clinical guidelines.

Original languageEnglish
Pages (from-to)1051-1065
Number of pages15
JournalJournal of Comparative Effectiveness Research
Volume9
Issue number15
DOIs
Publication statusPublished - Aug-2020

Keywords

  • comparative effectiveness research
  • gastroenterology
  • hepatology
  • infectious diseases
  • meta-analysis
  • systematic review
  • POSITIVE CHRONIC HEPATITIS
  • TENOFOVIR DISOPROXIL FUMARATE
  • E-ANTIGEN
  • ADEFOVIR DIPIVOXIL
  • PEGYLATED INTERFERON-ALPHA-2B
  • DOUBLE-BLIND
  • PEGINTERFERON ALPHA-2A
  • COMBINATION THERAPY
  • OPEN-LABEL
  • ANTIVIRAL TREATMENT

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