Comparative effectiveness of prophylactic strategies for perinatal transmission of hepatitis B virus: a network Meta-analysis of randomized controlled trials

Xiao-Feng Zhu ,Xun Zhuang ,Mengzhi Cai ,Yanli Hao ,Zhixian Chen ,Gang Qin

doi:10.3877/cma.j.issn.1674-1358.2018.04.002

Abstract

Objective To evaluate the effectiveness of interventions to block mother-to-child transmission of hepatitis B virus. Methods References and randomized control trials (RCT) related to HBV prevention of mother-to-child transmission were collected by retrieving the domestic and foreign electronic databases (from database establishment to December 31st, 2016). The four measures to intervene in mother-to-child transmission of HBV were placebo/none, active immunoprophylaxis [hepatitis B vaccine series starting at birth (HBVac)], passive-active immunoprophylaxis [hepatitis B immunoglobulin and vaccine (HBIG + HBVac)], prenatal HBIG administration (HBIG/HBIG + HBVac), and prenatal antiviral therapy (AVT/HBIG + HBVac). According to the selection criteria, the data was extracted for direct and network Meta analysis, relative risk (RR) and 95% confidence interval (CI) were used for evaluation. Results Total of 15 RCTs involving infants of HBV carrier mothers were eligible for analysis. Network meta-analysis demonstrated similar results as direct comparisons. HBVac alone significantly reduced the risk of HBV infection in infants of HBV carrier mothers (RR= 0.32, 95%CI: 0.21-0.50). Effect of the combination of immunoglobulin with vaccine (HBIG + HBVac) was better than HBVac alone (RR= 0.37, 95%CI: 0.20-0.67). In pregnant women with high viral load (HBV DNA≥2 × 105IU/ml), the treatment effect of HBIG/HBIG + HBVac and AVT/HBIG + HBVac was both better than that of HBIVac and HBVac in late pregnancy (RR= 0.47, 95%CI: 0.29-0.75;RR= 0.31, 95%CI: 0.10-0.99, respectively). Conclusions The antiviral therapy combined with injection of HBIG was effective in blocking the transmission of HBV in pregnant women, but the effect of HBIG injection in later stages of pregnancy was not yet accurate. Key words: Hepatitis B virus; Network meta-analysis; Perinatal transmission; Prophylaxis

Full Text