J Korean Med Sci.  2021 Apr;36(14):e89. 10.3346/jkms.2021.36.e89.

Entecavir versus Tenofovir for the Prevention of Hepatocellular Carcinoma in Treatment-naïve Chronic Hepatitis B Patients in Korea

• Choi H
• Seo GH

• KMID: 2514900
• DOI: http://doi.org/10.3346/jkms.2021.36.e89

Abstract

Background
The occurrence of hepatocellular carcinoma (HCC) is a major concern during antiviral therapy for chronic hepatitis B. There are conflicting opinions regarding the effects of entecavir (ETV) and tenofovir disoproxil fumarate (TDF) on HCC prevention. We assessed these two antiviral medications for preventing HCC in treatment-naïve patients with chronic hepatitis B.
Methods
We conducted a retrospective cohort study using nationwide claims data from the Korea Health Insurance Review and Assessment Service. We included 55,473 treatmentnaïve adult cases where ETV or TDF treatment was started between 2013 and 2017 (cohort 1). The ETV and TDF groups were matched 1:2 based on age, sex, comorbidities, hospital type, and index date year. Patients were followed up until December 2018. The outcome was the development of HCC. Subgroup analyses were conducted according to sex, age, hospital type and the presence of cirrhosis. We also compared the outcomes of patients who had started antiviral therapy during the 2012–2014 period (cohort 2).
Results
The matched participants (18,491 in the ETV and 36,982 in the TDF groups) were a part of the study for, on average, 41.2 months. The incidence of HCC did not differ significantly between the ETV (1.46 per 100 patient-years) and the TDF (1.36 per 100 patient-years) treatments (hazard ratio, 0.93; 95% confidence interval, 0.86–1.01; P = 0.081). By contrast, HCC incidence was significantly higher in the ETV group than tenofovir group of cohort 2.
Conclusion
In patients with chronic hepatitis B, the ETV treatment did not result in a higher rate of HCC than the TDF treatment.

Keyword

Tenofovir; Entecavir; Hepatocellular Carcinoma; Hepatitis B

Figure

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  Fig. 1 Flow diagram of the study population in matched set.ETV = entecavir, TDF = tenofovir disoproxil fumarate, COPD = chronic obstructive pulmonary disease.

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  Fig. 2 Cumulative incidence of hepatocellular carcinoma in matched sets treated with entecavir or tenofovir. Event rates were based on Kaplan-Meier estimates.HCC = hepatocellular carcinoma, TDF = tenofovir disoproxil fumarate, ETV = entecavir.

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  Fig. 3 Cumulative incidence of hepatocellular carcinoma in the 2012–2014 cohort matched sets treated with entecavir or tenofovir. Event rates were based on Kaplan-Meier estimates.HCC = hepatocellular carcinoma, TDF = tenofovir disoproxil fumarate, ETV = entecavir.

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