| Background: The renal function associated with anti-hepatitis B virus drugs is attracting increasing attention.Adefovir(ADV)is considered to be nephrotoxic.Recently,the potential improvement of telbivudine(LDT)on renal function in patients with chronic hepatitis B(CHB)has been recognized by several scholars.This systematic literature review and network meta-analysis aimed to assess renal function associated with telbivudine treatment compared to other nucleos(t)ide analogs(NAs)in patients with CHB in order to provide some references for clinically rational drug use.Methods: The Pub Med,EMBASE,Cochrane library,CBM,CNKI and Wanfang databases were searched for relevant articles appearing in the literature up to July 1,2017.Randomized controlled trials(RCTs)and cohort studies on the impact of five commonly used anti hepatitis B drugs on glomerular filtration rate(e GFR)in patients with CHB were included.All studies are assessed and the data analysis was performed by using the Review Manager 5.3.Results: A total of 705 studies were identified by the database searches and 19(7 RCTs and 12 cohort studies).Changes in e GFR(m L/min/1.73m2)from baseline and corresponding 95% credible intervals with various NAs after 48~52 weeks of treatment were as follows: LDT: 3.98[2.51,5.46],P<0.00001,the difference was significance;entecavir(ETV):-1.26[-3.22,0.71],P=0.21,the difference was not significance;lamivudine(LAM):-0.63[-3.56,2.30],P=0.67,the difference was not significance;tenofovir(TDF):-4.57[-6.79,-2.35],P<0.0001,the difference was significance;ADV:-3.95[-6.84,-1.06],P=0.007,the difference was significance.Besides,the change was 12.75[8.78,16.72] after 2 years of treatment of telbivudine.Furthermore,patients who had an abnormal GFR(60<e GFR<90m L/min/1.73m2)also had a major improvement after 1~2years of LDT treatment(11.53[8.94,14.13],P<0.00001).Conclusion: This Meta provides evidence that LDT is associated with significant improvement in renal function in patients with CHB,while others are not or had nephrotoxicity.The mechanism of the renal protective effect of LDT is still under investigation so further clinical and experimental investigations should be explored. |
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