A Meta Analysis Of 48-weeks Antiviral Therapy In Patients With HBeAg Negative Chronic Hepatitis B

Objective(s):We used meta-analysis to understand the negative conversion rate of HBV DNA?the normalization rate of ALT,and the clearance rates of HBsAg in HBeAg-negative chronic hepatitis B patients treated with antiviral therapy within 48 weeks,and compare the efficacy CHB 48-weeks antiviral therapy in patients with HBeAg negative chronic hepatitis B.Methods:Relevant literatures were searched in the Web of Science,PubMed and Embase databases,Wanfang data,CNKI and VP database from January 2000 to October 2019.Two researchers performed literature screening,data extraction and evaluation of literature quality.Statistical analyses were performed using RevMan 5.3 software.Results:1.13 articles were included,including 7 randomized controlled studies,6 cohort studies,4 Chinese literatures,and 9 English literatures.2.Six articles compared the rate of HBV DNA negative conversion at 48 weeks in IFN and NAs combined therapy and IFN monotherapy in HBeAg-negative CHB patients.IFN and NAs combined therapy compared with IFN monotherapy group of HBV DNA negative conversion rate in HBeAg-negative CHB patients at 48 weeks[RR=1.56,95%CI:1.36-2.01;P<0.00001],the difference was statistically significant.3.Three articles compared the rate of HBV DNA negative conversion at 48 weeks in IFN and NAs combined therapy and NAs monotherapy in HBeAg-negative CHB patients.IFN and NAs combined therapy compared with NAs monotherapy group of HBV DNA negative conversion rate in HBeAg-negative CHB patients at 48 weeks[RR=1.28,95%CI:1.10-1.50;P=0.001],the difference was statistically significant4.Six articles compared the normalization rate of ALT at 48 weeks in IFN and NAs combined therapy and IFN monotherapy in HBeAg-negative CHB patients.IFN and NAs combined therapy compared with IFN monotherapy group of normalization rate of ALT in HBeAg-negative CHB patients at 48 weeks[RR=1.18,95%CI:1.06-1.32;P=0.003],the difference was statistically significant.5.Three articles compared the normalization rate of ALT at 48 weeks in IFN and NAs combined therapy and NAs monotherapy in HBeAg-negative CHB patients.IFN and NAs combined therapy compared with NAs monotherapy group of normalization rate of ALT in HBeAg-negative CHB patients at 48 weeks[RR=0.99,95%CI:0.93-1.05;P=0.70],the difference is not statistically significant.6.Two articles compared the clearance rates of HBsAg IFN between IFN and NAs combined therapy and IFN monotherapy in HBeAg-negative CHB patients at 48 weeks.IFN and NAs combined therapy compared with IFN monotherapy group of the clearance rate of HBsAg in HBeAg-negative CHB patients at 48 weeks[RR=1.69,95%CI:1.30-2.21;P=0.0001],the difference was statistically significant.7.Three articles compared the clearance rate of HBsAg between IFN and NAs combined therapy with NAs monotherapy in HBeAg-negative CHB patients at 48 weeks.IFN and NAs combined therapy compared with NAs monotherapy group of the clearance rate of HBsAg in HBeAg-negative CHB patients at 48 weeks[RR=1.80,95%CI:1.36-2.39;P<0.0001],the difference was statistically significant.8.Six articles compared the negative conversion rate of HBV DNA between HBeAg-negative CHB group and HBeAg-positive CHB group at 48 weeks of NAs antiviral treatment.After 48 weeks of antiviral therapy with NAs,the negative conversion rate of HBV DNA in HBeAg-negative CHB group was compared with HBeAg-positive CHB group.[RR=1.61,95%CI:1.19-1.56,P<0.00001],the difference was statistically significant.Subgroup analysis suggested that when treated with ADV?ETV?TDF,compared with HBeAg positive CHB group,HBV DNA negative conversion rate of HBeAg negative CHB patients was[RR=2.01,95%CI:1.60-2.54,P<0.00001],[RR=1.11,95%CI:1.04-1.18,P=0.0007],[RR=1.31,95%CI:1.22-1.41,P<0.00001],the differences are statistically significant.9.Two articles compared the rate of ALT recurrence between the HBeAg-negative CHB group and the HBeAg-positive CHB group at 48 weeks of NAs antiviral treatment.During the 48 weeks of NAs antiviral treatment,the rate of ALT recurrence in the HBeAg-negative CHB group was compared with the HBeAg-positive CHB group[RR=0.96,95%CI:0.90-1.03,P=0.30),the difference was not statistically significant.Conclusion(s):1.For HBeAg-negative CHB patients,the negative conversion rate of HBV DNA at 48 weeks after combined treatment IFN and NAs is superior to the IFN monotherapy group and NAs monotherapy group,but the combination of IFN and NAs,IFN monotherapy and NAs monotherapy had no difference in ALT recovery rate at 48 weeks.2.For HBeAg-negative CHB patients,the clearance rate of HBsAg at 48 weeks after combined treatment with IFN and NAs is superior to the IFN monotherapy group and NAs monotherapy group.3.Compared with HBeAg-positive CHB patients,NAs antiviral therapy has a more significant effect on HBV DNA negative conversion rate of HBeAg-negative CHB at 48 weeks.