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 Hassan Murad; Khaled Mohammed

doi:10.1002/hep.28280

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 Hassan Murad, Khaled Mohammed

Research output: Contribution to journal › Review article › peer-review

235 Scopus citations

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 language	English (US)
Pages (from-to)	284-306
Number of pages	23
Journal	Hepatology
Volume	63
Issue number	1
DOIs	https://doi.org/10.1002/hep.28280
State	Published - Jan 1 2016

ASJC Scopus subject areas

Hepatology

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Lok, A. S. F., Mcmahon, B. J., Brown, R. S., Wong, J. B., Ahmed, A. T., Farah, W., Almasri, J., Alahdab, F., Benkhadra, K., Mouchli, M. A., Singh, S., Mohamed, E. A., Abu Dabrh, A. M., Prokop, L. J., Wang, Z., Murad, M. H., & 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

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

@article{e7d7379162df46b184c32679251fc507,

title = "Antiviral therapy for chronic hepatitis B viral infection in adults: A systematic review and meta-analysis",

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.",

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

note = "Publisher Copyright: {\textcopyright} 2016 by the American Association for the Study of Liver Diseases.",

year = "2016",

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doi = "10.1002/hep.28280",

language = "English (US)",

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T1 - Antiviral therapy for chronic hepatitis B viral infection in adults

T2 - A systematic review and meta-analysis

AU - Lok, Anna S.F.

AU - Mcmahon, Brian J.

AU - Brown, Robert S.

AU - Wong, John B.

AU - Ahmed, Ahmed T.

AU - Farah, Wigdan

AU - Almasri, Jehad

AU - Alahdab, Fares

AU - Benkhadra, Khalid

AU - Mouchli, Mohamed A.

AU - Singh, Siddharth

AU - Mohamed, Essa A.

AU - Abu Dabrh, Abd Moain

AU - Prokop, Larry J.

AU - Wang, Zhen

AU - Murad, Mohammad Hassan

AU - Mohammed, Khaled

PY - 2016/1/1

Y1 - 2016/1/1

N2 - 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.

AB - 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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U2 - 10.1002/hep.28280

DO - 10.1002/hep.28280

M3 - Review article

C2 - 26566246

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SN - 0270-9139

VL - 63

SP - 284

EP - 306

JO - Hepatology

JF - Hepatology

IS - 1

ER -

Antiviral therapy for chronic hepatitis B viral infection in adults: A systematic review and meta-analysis

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