J. Reichen, MD
In patients with chronic hepatitis B infection, is antiviral therapy effective?
Included studies evaluated antiviral drugs (interferon-α2b or pegylated-α2a, lamivudine, adefovir, entecavir, and telbivudine) for ≥ 24 weeks in ≥ 50 patients with chronic hepatitis B. Exclusion criteria included pregnancy, hepatocellular carcinoma or HIV infection, or chemotherapy or liver transplantation. Outcomes included death, hepatocellular carcinoma, hepatic decompensation, and cirrhosis.
MEDLINE, Cochrane Library, Medwatch, United Kingdom Current Problems in Pharmacovigilance, and European Public Assessment Report were searched from 1990 to 2008 for randomized controlled trials (RCTs). 60 RCTs (78% men) met the selection criteria; 16 RCTs (n = 4431) reported clinical outcomes. Most RCTs did not have sufficient power to evaluate the effects of antiviral drugs on clinical outcomes.
Meta-analysis showed that entecavir and lamivudine did not differ for death or hepatic decompensation (Table); different doses of interferon-α2b did not differ for death (Table). Individual RCTs showed that antiviral drugs did not differ from placebo; other therapies; or no treatment for death, hepatocellular carcinoma, hepatic decompensation, or cirrhosis.
Evidence is insufficient to evaluate effectiveness of antiviral therapies for chronic hepatitis B.
Antiviral therapies for chronic hepatitis B infection*
*Analysis based on a random-effect model.
Reichen J. Review: Evidence is insufficient to evaluate effectiveness of antiviral therapies for chronic hepatitis B. Ann Intern Med. ;150:JC5–6. doi: 10.7326/0003-4819-150-10-200905190-02006
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Published: Ann Intern Med. 2009;150(10):JC5-6.
Gastroenterology/Hepatology, Infectious Disease, Liver Disease.
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