Lower Hepatocellular Carcinoma Risk With Tenofovir Than With Entecavir in Patients With Hepatitis B Virus: Presented at EASL

By Walter Alexander

VIENNA, Austria -- April 17, 2019 -- Treatment with tenofovir entails lower risk of hepatocellular carcinoma than treatment with entecavir, according to a study presented here at The International Liver Meeting, the 54th Annual Meeting of the European Association for the Study of the Liver (EASL).

Both drugs are potent antiviral agents with high efficacy and high genetic barriers to resistance, and they are equally recommended as the first-line treatment for chronic hepatitis B.

A recent South Korean study suggested that tenofovir-treated patients have a lower risk of hepatocellular carcinoma than patients receiving entecavir, said Terry Cheuk Fung Yip, MD, The Chinese University of Hong Kong, Hong Kong, China, on April 13.

This led to the current observational comparison of hepatocellular carcinoma risk among patients receiving tenofovir or entecavir. It included 29,350 adult patients with chronic hepatitis B (mean age, 60 years; 64% male) initially treated with tenofovir or entecavir for ≥6 months between January 2008 and June 2018. Inpatient/outpatient data were collected from all Hong Kong public hospitals and clinics. In all, 1,309 patients were initially treated with tenofovir and 28,041 were treated with entecavir.

Analysis showed that after a median follow-up of 3.6 years, hepatocellular carcinoma developed in 0.6% of tenofovir patients and 4.9% of entecavir-treated patients. The 5-year incidence of hepatocellular carcinoma was 7.0% and 1.1% in the tenofovir and entecavir groups, respectively (subdistribution hazard ratio [HR], 0.32; adjusted P = .001). Furthermore, a propensity weighting analysis showed a robustly lower risk in tenofovir-treated patients (weighted subdistribution HR, 0.36; P = .013). The propensity score took into account patient demographics, hepatitis B virological markers, liver and renal function, cirrhosis and complications, comorbidities, and treatment initialisation year.

“Tenofovir was associated with a significantly lower risk of hepatocellular carcinoma than entecavir in this large population of adults with chronic hepatitis B virus infection,” Dr. Yip concluded, adding, “Although we recognise the inherent limitations of observational data, our findings are consistent with those of the Korean group.”

[Presentation title: Tenofovir Treatment Has Lower Risk of Hepatocellular Carcinoma Than Entecavir Treatment in Patients With Chronic Hepatitis B. Abstract LB-03]

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