Lamivudine and Entecavir for Acute Hepatitis B: A Systematic Review and Meta-Analysis.
Autor: Henríquez Camacho, César; Hijas-Gomez, Ana Isabel; Risco Risco, Carlos; Ruiz Lapuente, Maria Angeles; Escudero-Sanchez, Rosa; Moreno Cuerda, Víctor
Resumen: Background. Acute hepatitis B infection is associated with severe liver disease and chronic
sequelae in some cases. The purpose of this review was to determine the efficacy of nucleoside
analogues (NA) (lamivudine versus entecavir) compared to placebo or no intervention for treating
acute primary HBV infection. Methods. A meta-analysis for drug intervention was performed, following
a fixed-effect model. Randomized controlled trials (RCTs) and quasi-randomized studies that
evaluated the outcomes of NA in acute hepatitis B infection were included. The following outcomes
were considered: virological cure (PCR negative), elimination of acute infection (seroconversion of
HBsAg), mortality, and serious adverse events. Results. Five trials with 627 adult participants with
severe acute hepatitis B defined by biochemical and serologic parameters were included. Virological
cure did not favor any intervention: OR 0.96, 95% CI 0.54 to 1.7 (p = 0.90), I2 = 58%. Seroconversion
of HBsAg to negative favored placebo/standard-of-care compared to lamivudine: OR 0.54, 95%
CI 0.33 to 0.9 (p = 0.02), I2 = 31%. The only trial that compared entecavir and lamivudine favored
entecavir over lamivudine (OR: 3.64, 95% CI 1.31–10.13; 90 participants). Adverse events were
mild. Conclusion. There is insufficient evidence that NA obtain superior efficacy compared with
placebo/standard-of-care in patients with acute viral hepatitis, based on low quality evidence.
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