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- The China Questions: Critical Insights into a Rising Power
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The China Questions: Critical Insights into a Rising Power
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Jinan Huaiyin·Jinan West Railway Station· Locals Apartment , China - www.pelletpont.hu
Visit website. Privacy Policy. More by Cupid Media See more. Cupid Media. In the absence of head-to-head RCTs, several groups have recently conducted retrospective cohort analyses of CHB patients receiving these therapies in order to generate real-world data on their comparative effectiveness. These studies have generated varying results and are not unified in their conclusions. In line with this, the present systematic review and meta-analysis set out to identify and synthesize all available retrospective cohort data that concerned the efficacy of these 2 high-potency antivirals in the context of patients with CHB.
Following the identification of 7 similarly designed studies containing 45, participants, our meta-analysis found that TDF use was associated with a lower incidence of HCC when compared to ETV HR 0. Although TDF-treated cohorts were found to develop fewer cases of HCC in the combined analysis model, just 2 of the 7 included studies demonstrated the same significant effect independently [ 9 , 17 ], while the remaining studies identified no such difference between the 2 therapeutic options.
An editorial by Flemming et al. Indeed, Yip et al. In line with the current meta-analysis, the results of the retrospective analysis of administrative data by Choi et al. In general, ETV performed comparably in propensity score-adjusted models between this study and that reported by Lee et al. The source of this significant disparity is not entirely clear at present; however, Lee et al.
Nevertheless, Choi et al. Although their findings were broadly consistent with our findings, a strength of our study is the inclusion of the large cohort study that has recently been published [ 9 ]. This has not featured in other reviews. Our study also has the advantage of not using unadjusted crude data to estimate risks.
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We also used propensity score matching to minimize the risk of selection bias in our analysis. The studies included and the meta-analysis itself have several notable strengths and limitations associated with them. In general, the included studies all reported a similar design, with roughly comparable duration of follow-up, cohort sizes, and cohort compositions.
However, due to the nature of these observational studies, there may be additional unidentified and unmeasured factors that have impacted substantially upon the outcome. Our findings must be interpreted within the context that all included studies are based on observational cohort studies, themselves at risk of selection bias.
This is indeed a shortcoming of these retrospective studies and an aspect that could be remedied effectively through an RCT. The mean reported follow-up times ranged between 3 and 5 years, and, although this appears to have been sufficiently long to incur an analyzable number of HCC cases, it will be important that subsequent studies aim to understand the longer term effects of both treatments.
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In addition, the studies included in this meta-analysis are composed almost exclusively of Asian cohorts, and, although several Asian countries commonly report concerningly high rates of CHB, this limits the generalizability of the result and indicates that future work is required in regions with similarly high incidence rates, such as Africa.
Similarly, it will now be important to tease out if each genotype of the HBV responds in a similar fashion. This is important since it is possible that patients may require a therapy switch from one to another due to intolerable side effects or development of viral resistance, both of which may have significant impact upon the efficacy of the therapy and, therefore, the risk of HCC development.
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TDF and ETV have both proven to be effective therapeutic options in the management of CHB, as assessed by viral load and hepatic biochemistry parameters. However, there is little understanding of whether one of these antivirals is superior to the other in terms of HCC prevention. We uncovered 7 suitable studies that included data from 45, CHB patients and conducted a meta-analysis that combined the reported HRs.
However, well-designed and large-scale due to inherently low event rates RCTs are now warranted to further validate this result by attempting to exclude any remaining potential bias or confounding. All authors reviewed the final draft. Author Contacts Guangsheng Yu. Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor s.
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