Efficacy and Safety of Lamivudine Combined with Adefovir Dipivoxil versus Entecavir Alone in the Treat-ment of Decompensated HBV-associated Cirrhosis:A Meta-analysis / 中国药房

ABSTRACT

OBJECTIVE:To systematically review the efficacy and safety of lamivudine(LAM)combined with adefovir dipiv-oxil (ADV) versus entecavir (ETV)alone in the treatment of decompensated HBV-associated cirrhosis. METHODS:Retrieved from PubMed,Cochrane Library,CBM,CNKI,VIP and WangFang Database, randomized controlled trails (RCT) about LAM combined with ADV(combination group)versus ETV(control group)in the treatment of decompensated HBV-associated cirrhosis were collected. Meta-analysis was performed by using Stata 11.0 software after data extraction and quality evaluation. RESULTS:Totally 13 RCTs were included,involving 972 patients. Results of Meta-analysis showed,there were no significant differences in the serum alanine transaminase (ALT)[SMD=0.079,95%CI(-0.086,0.244),P=0.348],total bilirubin (TBIL) [SMD=0.056, 95%CI(-0.118,0.230),P=0.529],ALB[SMD=-0.020,95%CI(-0.494,0.454),P=0.935],HBV-DNA negative conversion rate [RR=1.012,95%CI(0.950,1.079),P=0.710],HBV e antigen(HBeAg)seroconversion rate [RR=1.181,95%CI(0.969,1.439), P=0.099],HBeAg negative conversion rate [RR=1.011,95%CI(0.860,1.189),P=0.893],follow-up 96 week liver function Child-Turcotte-Pugh score [SMD=-0.063,95%CI(-0.299,0.173),P=0.601],virological breakthrough rate [RR=1.562,95%CI (0.471,5.178),P=0.466],mortality rate [RR=1.198,95%CI(0.624,2.300),P=0.587] and the incidence of adverse reactions [RR=1.552,95%CI(0.618,3.900),P=0.349]in 2 groups;follow-up 48 week liver function CTP score in combination group was significantly higher than control group,the difference was statistically significant [SMD=0.352,95%CI(0.031,0.672),P=0.031]. CONCLUSIONS:LAM combined with ADV shows similar efficacy and safety to ETV in the treatment of decompensated HBV-as-sociated cirrhosis,but within short term(48 weeks),ETV is more likely to inhibit the development of liver fibrosis of the chronic HBV patients,and even can reverse liver fibrosis and cirrhosis.