Comparative Study of Treatment Outcome With Tenofovir and Telbivudine in Patients With Hepatitis B Related Acute on Chronic Liver Failure

Abstract

Background and Aim: General objective was to study the differences in treatment outcome with tenofovir and telbivudine in ACLF-B patients. Specific objectives were to observe survival at 90 days and calculate CTP score and MELD score in these two groups. Methods: Consecutive patients (n = 30) of ACLF-B were enrolled in this study and randomized into two groups. One group (15 patients) was treated with tenofovir 300 mg daily and the other group (15 patients) with telbivudine 600 mg daily and followed up for 90 days with treatment. ACLF was defined based on APASL 2014 criteria and organ failure by CANONIC study criteria. Chronic cause was hepatitis B virus infection (CHB/HBV related cirrhosis) and acute insult was caused by HBV reactivation/flare. Results: Most of the study patients were below 50 years of age with male predominance and baseline investigations showed no significant difference except AST (328.5 ± 167.3 in tenofovir and 197 ± 110.6 in telbivudine group, P value 0.017) and serum creatinine (1.1 ± 0.4 in tenofovir and 2.3 ± 0.5 in telbivudine group, P value 0.001). At 90 days of antiviral treatment both groups showed significant clinical improvement along with CTP score and MELD score. In comparison, tenofovir significantly improved MELD score than telbivudine therapy (12.08 ± 2.84 in tenofovir and 14.41 ± 1.76 in telbivudine group, P value 0.043). At 90 days, 12 out of 15 patients (80%) survived with tenofovir therapy and 9 out of 15 patients (60%) with telbivudine therapy, but this was not statistically significant. Conclusion: In patients of HBV-ACLF, antiviral therapy, both tenofovir and telbivudine improve liver function and survival, but there is no statistically significant difference in survival between these two groups. The authors have none to declare.