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Objective:Published network meta-analyses of chronic hepatitis B (CHB) treatments are either out-of-date or excluded key treatments.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 language | English |
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Pages (from-to) | 1051-1065 |
Number of pages | 15 |
Journal | Journal of Comparative Effectiveness Research |
Volume | 9 |
Issue number | 15 |
DOIs | |
Publication status | Published - 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