Abstract
Evidence about the clinical effects of entecavir (ETV) for patients with hepatitis B decompensated cirrhosis remain controversial. Therefore, we perform this meta-analysis to assess the treatment outcomes of ETV in participants with hepatitis B decompensated cirrhosis. Relevant studies were identified by searching databases until the March 2016. A random-effects model was used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs). GRADEprofiler3.6 was used to evaluate the quality of the evidence. A total of 26 studies (involving 2040 patients) were included. The quality of the evidence was classified from very low to high by the GRADED approach for all included RCTs. Meta-analysis showed that patients were more likely to experience HBV-DNA loss (RR:1.85, 95%CIs: 1.41 to 2.43, P < 0.0001 at 48 weeks), have normalized alanine aminotransferase levels (ALT) (P = 0.003 at 24 weeks, P = 0.02 at 48 weeks), and have a low mortality rate at 24 weeks (P = 0.003) when treated with ETV. There was no significant different between ETV and the control groups at the total mortality (P = 0.06) and HBeAg seroconversion (P = 0.14). In conclusion, ETV could be the first line therapy for patients with HBV related decompensated cirrhosis, because ETV could reduce the early mortality and move HBV DNA load down.
Highlights
Evidence about the clinical effects of entecavir (ETV) for patients with hepatitis B decompensated cirrhosis remain controversial
Proved[8] that patients generally had a good tolerance to ETV in the treatment of hepatitis B virus (HBV) related decompensated cirrhosis, ETV had a better virus response than adefovir dipivoxil (ADV), and mortality of patients with ETV was similar with lamivudine (LAM) by a randomized, open-label study
The number of patients who were treated with other nucleos(t)ide analogues (NAs) drugs except ETV were 561, 549 patients were not treated by NAs drugs
Summary
Evidence about the clinical effects of entecavir (ETV) for patients with hepatitis B decompensated cirrhosis remain controversial. Decompensated cirrhosis[3] is characterized by significant abnormalities in liver functions, including raised serum bilirubin levels, a prolonged prothrombin time and/or the occurrence of complications such as ascites, hepatic encephalopathy and variceal bleeding. It is necessary for patients with hepatitis B decompensated liver diseases to be treated. Proved[8] that patients generally had a good tolerance to ETV in the treatment of HBV related decompensated cirrhosis, ETV had a better virus response than adefovir dipivoxil (ADV), and mortality of patients with ETV was similar with lamivudine (LAM) by a randomized, open-label study. Keating GM 3showed that patients had a significant liver function improvements from baseline after 12 months treatment of ETV in patients with decompensated cirrhosis
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