| ObjectiveThere are 350-400 million hepatitis B patients worldwide.China is a country with a high incidence of hepatitis B.There are about 190 million HBV carriers,accounting for8% to 10% of the total population of China.Among them,there are about 220 million CHB patients.At present,there is no effective drug therapy for hepatitis B to achieve the cure of CHB or functional cure.ETV,LAM,ADV and other drugs are currently used in the market for the treatment of hepatitis B in China.LAM has a very high drug resistance rate,the drug resistance rate is as high as 67% within 4 years,more than 70% of patients develop drug resistance after 5 years.In five years of clinical trials,29% of ADV patients developed drug resistance at a moderate level.ETV has a very low resistance rate and is a high resistance barrier drug.It has been reported that LAM combined with ADV treatment has significantly reduced the drug resistance rate of the two drugs.According to the guidelines,ETV,TDF or Peg IFN(A1)should be given priority in the treatment of HBe Ag positive or negative CHB patients.At present,TDF is on the market in China soon,the safety of long-term medication is not clear,and the price is expensive.Therefore,most of the newly treated patients with chronic hepatitis B are still treated with ETV alone or LAM combined with ADV.This article mainly compares and evaluates the efficacy and safety of ETV single drug therapy and LAM combined with ADV,so as to provide the basis for the choice of clinical treatment.MethodUsing "entecavir,ETV,lamivudine,LAM,adefovir,ADV,Chronic hepatitis B,HBV" as the Chinese search term,we retrieved the documents of CNKI,Pubmed,Wanfang,Weipu and CBM databases from 2007 to 2017,and manually retrieved relevant references and conference abstracts.In order to compare the efficacy and safety of ETV and LAM combined with ADV in the initial treatment of CHB,we searched PCT as comprehensively as possible.After defining the literature,we formulated the criteria for inclusion and exclusion,screened strictly according to the criteria,and evaluated the selected literature by two independent evaluators.Then we used Rev Man 5.3 software to combine and analyze the data,and drew the final conclusion.On Guiding Clinical Therapy and Drug Application ResultAfter searching the database,612 literatures were initially detected.By reading the title and abstract,546 documents that obviously did not meet the requirements were deleted,and the remaining 66 articles were read in full.41 of them did not meet the inclusion criteria,and 10 were incomplete in data statistics.Thirteen papers were eligible for inclusion and could be used for Meta-analysis.Of the 13 literatures,11 were Chinese and 2 were foreign.The total number of cases included was 1274.Thirteen papers,including 10 high-quality papers and 3 low-quality papers,show that the overall quality of the papers included in this study is acceptable.According to the combined analysis of 12,24,48 and 96 weeks of drug use,there were no significant differences in HBV DNA negative conversion rate,ALT normalization rate,HBe Ag negative conversion rate,HBe Ag and HBe Ab conversion rate between the two groups.There was no significant difference in drug resistance between the two groups at 96 weeks of treatment,and no significant difference in adverse reactions between the two groups at 96 weeks of treatment.ConclusionETV and LAM combined with ADV have similar efficacy in the initial treatment of CHB patients,and there is little difference in drug resistance and adverse reactions between them.They have similar safety.LAM combined with ADV is a feasible treatment for patients with limited economic conditions.However,since the study included in this study was followed up to 96 weeks at most,the long-term efficacy,drug resistance and adverse reactions need to be further explored by more long-term,large-sample studies. |
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