Efficacy of nucleotides/nucleosides in preventing virus reactivation in tumor patients with HBV infection after chemotherapy: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHAO Yuqing ^1,2 , SONG Yingying ² , YANG Yidian ^1,2 ,  ZHANG Liping ^1,2

1. Beijing University of Chinese Medicine, Beijing 100029, P.R.China;
2. Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, P.R.China;

Corresponding author：

ZHANG Liping, Email: lpzhang2005@126.com

Keywords：

Cancer patients; Hepatitis B virus; Reactivation; Nucleotides/Nucleosides; Randomized controlled trial; Network meta-analysis

DOI：

10.7507/1672-2531.202106160

Video：

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Objective To systematically review the efficacy of different nucleosides (acids) in preventing hepatitis B virus reactivation after chemotherapy in cancer patients. Methods The Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of different nucleosides (acids) to prevent HBV reactivation after chemotherapy in cancer patients from inception to June 7^th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Network meta-analysis was then performed by using Stata 16.0 software. Results A total of 43 RCTs involving 3 269 patients were included. There were 7 interventions, namely entecavir (ETV), lamivudine (LAM), adefovir dipivoxil (ADV), telbivudine (LdT), tenofovir dipivoxil (TDF), lamivudine combined with entecavir (LAM+ETV), and lamivudine combined with adefovir dipivoxil (LAM+ADV). The results of network meta-analysis showed that the efficacy of reducing the reactivation rate of ETV, LAM, ADV, LdT, TDF, LAM+ETV, LAM+ADV were superior than the control group. The ETV, LAM and ADV were not as effective as LAM+ETV. The leading drug combinations were LAM+ETV (94.8%), LdT (81.5%) and LA+ADV (58.0%). Conclusions Current evidence shows that LAM+ETV, LdT, and LA+ADV are more effective in preventing hepatitis B virus reactivation after chemotherapy in cancer patients. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.

Citation： ZHAO Yuqing, SONG Yingying, YANG Yidian, ZHANG Liping. Efficacy of nucleotides/nucleosides in preventing virus reactivation in tumor patients with HBV infection after chemotherapy: a network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(11): 1269-1277. doi: 10.7507/1672-2531.202106160 Copy

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1. Paul S, Saxena A, Terrin N, et al. Hepatitis B virus reactivation and prophylaxis during solid tumor chemotherapy: a systematic review and meta-analysis. Ann Intern Med, 2016, 164(1): 30-40.
2. 王贵强, 王福生, 庄辉, 等. 慢性乙型肝炎防治指南(2019年版). 中国病毒病杂志, 2020, 10(1): 1-25.
3. 马军, 秦叔逵, 缪晓辉, 等. 淋巴瘤免疫化疗HBV再激活预防和治疗中国专家共识. 临床肿瘤学杂志, 2013, 18(10): 935-942.
4. 中华医学会血液学分会, 中国抗癌协会淋巴瘤专业委员会, 中华医学会肝病学分会. 中国淋巴瘤合并HBV感染患者管理专家共识. 中华血液学杂志, 2013, 34(11): 988-993.
5. 李梦苑, 叶传涛, 张颖, 等. HBV复制再激活研究进展. 临床肝胆病杂志, 2017, 33(4): 751-756.
6. Yeo W, Chan TC, Leung NW, et al. Hepatitis B virus reactivation in lymphoma patients with prior resolved hepatitis B undergoing anticancer therapy with or without rituximab. J Clin Oncol, 2009, 27(4): 605-611.
7. Svicher V, Salpini R, Malagnino V, et al. New markers in monitoring the reactivation of hepatitis B virus infection in immunocompromised hosts. Viruses, 2019, 11(9): 783.
8. Maini MK, Gehring AJ. The role of innate immunity in the immunopathology and treatment of HBV infection. J Hepatol, 2016, 64(Suppl 1): S60-S70.
9. Loomba R, Liang TJ. Hepatitis B reactivation associated with immune suppressive and biological modifier therapies: current concepts, management strategies, and future directions. Gastroenterology, 2017, 152(6): 1297-1309.
10. He L, Liu X, Zhao Y, et al. Efficacy of nucleot(s)ide analogs therapy in patients with unresectable hbv-related hepatocellular carcinoma: a systematic review and meta-analysis. Dis Markers, 2017, 2017: 7075935.
11. 刘宗财, 骆文静, 孙冠超, 等. 恩替卡韦在核苷酸类似物中治疗慢性乙型肝炎的疗效. 医学食疗与健康, 2021, 19(7): 49-50.
12. European Association for the Study of the Liver. EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol, 2017, 67(2): 370-398.
13. Liaw YF, Kao JH, Piratvisuth T, et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2012 update. Hepatol Int, 2012, 6(3): 531-561.
14. Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology, 2018, 67(4): 1560-1599.
15. Yeo W, Chan PK, Zhong S, et al. Frequency of hepatitis B virus reactivation in cancer patients undergoing cytotoxic chemotherapy: a prospective study of 626 patients with identification of risk factors. J Med Virol, 2000, 62(3): 299-307.
16. Chess LE, Gagnier J. Risk of bias of randomized controlled trials published in orthopaedic journals. BMC Med Res Methodol, 2013, 13: 76.
17. Higgins JP, Altman DG, Gøtzsche PC, et al. The cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
18. 李赓, 高健全. 抗病毒治疗对鼻咽癌合并HBsAg阳性患者乙肝病毒再激活的预防效果探究. 中国地方病防治杂志, 2019, 34(3): 328-330.
19. Liu WP, Xiao XB, Xue M, et al. Prophylactic use of entecavir for lymphoma patients with past hepatitis B virus infection: a randomized controlled trial. Clin Lymphoma Myeloma Leuk, 2019, 19(2): 103-108.
20. 占国清, 谭华炳, 李芳, 等. 恩替卡韦抗病毒对TACE治疗的HBV DNA阴性乙型肝炎相关性肝癌的影响. 实用肝脏病杂志, 2018, 21(1): 96-99.
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