Tenofovir is superior to entecavir in reducing HCC for patients with HBV-related compensated cirrhosis at high HCC risk scores

Yan Huang; Lichang Chen; Rui Huang; Chuanwu Zhu; Jia Shang; Yunsong Qian; Jianqi Lian; Longgen Liu; Jianning Jiang; Chenghai Liu; Honglian Gui; Qing Xie

doi:10.1177/20406223221102791

Tenofovir is superior to entecavir in reducing HCC for patients with HBV-related compensated cirrhosis at high HCC risk scores

Ther Adv Chronic Dis. 2022 Jun 21:13:20406223221102791. doi: 10.1177/20406223221102791. eCollection 2022.

Authors

Yan Huang¹, Lichang Chen¹, Rui Huang², Chuanwu Zhu³, Jia Shang⁴, Yunsong Qian⁵, Jianqi Lian⁶, Longgen Liu⁷, Jianning Jiang⁸, Chenghai Liu⁹, Honglian Gui¹⁰, Qing Xie¹⁰

Affiliations

¹ Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Infectious Disease, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.
³ Department of Infectious Diseases, The Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China.
⁴ Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, China.
⁵ Department of Hepatology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China.
⁶ Department of Infectious Diseases, Tangdu Hospital, The Fourth Military Medical University, Xian, China.
⁷ Department of Infectious Diseases, The Third People's Hospital of Changzhou, Changzhou, China.
⁸ Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
⁹ Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
¹⁰ Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.

Abstract

Background: Both tenofovir disoproxil fumarate (TDF) and entecavir (ETV) are known to reduce the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). This study aimed to compare the difference in HCC risk reduction between TDF and ETV in treatment-naïve patients with CHB-related compensated cirrhosis.

Methods: Patients with compensated cirrhosis initially treated with TDF or ETV at nine Chinese hospitals between June 2014 and March 2021 were enrolled in this retrospective study. The cumulative HCC incidence rates for the two drugs were compared for the entire cohort, and a subgroup analysis was performed according to the HCC risk scores. Propensity score matching (PSM) was used to control confounding biases.

Results: The analysis included 1453 patients (TDF group, n = 188; ETV group, n = 1265). Ninety-five patients developed HCC, with a median follow-up period of 26.1 months. The 3-year HCC incidence was 2.0% in the TDF group and 7.5% in the ETV group (log-rank p = 0.005). TDF treatment was associated with a lower risk of HCC than ETV treatment [hazard ratio (HR) = 0.222, 95% confidence interval (CI), 0.070-0.702, p = 0.010] but was similar after PSM (HR = 0.483, 95% CI, 0.144-1.626, p = 0.240; log-rank p = 0.230). However, subgroup analysis showed that the cumulative HCC incidence was lower in the TDF group than in the ETV group among patients with a modified PAGE-B score (mPAGE-B) ⩾9, either before or after PSM (log-rank p = 0.048 and p = 0.023, respectively).

Conclusion: Among patients with an mPAGE-B score ⩾9, TDF is associated with a lower HCC incidence than ETV in patients with CHB-related compensated cirrhosis.

Keywords: chronic hepatitis B; compensated cirrhosis; entecavir; hepatocellular carcinoma; modified PAGE-B score; risk scores; tenofovir disoproxil fumarate.