REVIEW Open AccessComparison of the 48-week efficacy betweenentecavir and adefovir in HBeAg-positive nucleos(t)ide-naïve Asian patients with chronic hepatitis B:a meta-analysisPan Zhao 1* , Weiwei Liu 2 , Jun Zhao 1* , Qun Guan 1AbstractBackground: Although entacavir and adefovir were widely used in most Asian countries, there were few conclusionsdrawn from a meta-analysis for comparing the efficacy between entecavir and adefovir in nucleos(t)ide-naïve Asianpatients with chronic hepatitis B (CHB). The aim of this study was to evaluate the 48-week efficacy between the twodrugs in HBeAg-positive nucleos(t)ide-naïve Asian CHB patients with the method of Meta analysis, which was generallyaccepted by the international as the best evidence for evaluating the efficacy of drugs.Methods: We searched all data documented in Pubmed, Embase, Wanfang Database and CNKI (China NationalKnowledge Infrastructure) before November 30, 2010. Heterogeneity was examined by Chi-square test, the relativerisk calculated and forest plot drawn. Rates of undetected serum HBV DNA, serum alanine aminotransferase (ALT)normalization, HBeAg clearance and HBeAg seroconversion were analyzed. A total of 6 articles was included. Metaanalysis showed that the rate of undetected serum HBV DNA (relative risk, 1.73; 95% confidence interval, 1.38-2.17;P < 0.00001) and that of serum ALT normalization (relative risk, 1.25; 95% confidence interval, 1.06-1.49; P = 0.009)in the entecavir group were higher than those in the adefovir group. However, no statistic significance existedbetween the two groups in the rate of HBeAg clearance (relative risk, 0.77; 95% confidence interval, 0.44-1.35; P =0.36), or the rate of HBeAg seroconversion (relative risk, 0.74; 95% confidence interval, 0.28-1.94; P = 0.53).Conclusions: Entecavir is superior to adefovir in decreasing serum HBV DNA and normalizing ALT but similar withadefovir in clearing HBeAg and encouraging HBeAg seroconversion for the HBeAg-positive nucleos(t)ide-naiveAsian patients with chronic hepatitis B. Adefovir can be still used for first-line therapy in these patients.1. IntroductionInfection with HBV is a major public health problem.Approximately 2 billion people have been exposed to HBV,and more than about 350 million are chronically infectedwith HBV [1]. Chronic hepatitis B (CHB) can lead to life-threatening conditions like liver cirrhosis (LC) and hepato-cellular carcinoma (HCC) [2-4]. By the effective anti-HBVtherapy, the worsening progress may be blocked or delayed.Oral nucleoside and nucleotide analogues (NAs) have revo-lutionized the treatment of chronic hepatitis B, which cansuppress HBV replication in most patients and improvetransaminase levels. To date, three nucleoside analogues(lamivudine, entecavir, telbivudine) and one nucleotide ana-logue (adefovir) are approved for the treatment of HBVinfection in most of Asian countries. It can be confirmedthat NAs have exhibited powerful strength in improvingliver histology in most patients, however, two major short-comings of NAs therapy frequently negate the benefits.One is the high rate of virological relapse when treatment isdiscontinued, and the other is the development of antiviraldrug resistance when treatment is administered in longterm [5]. Consequently, clinically relevant indicators for theefficacy in therapy of chronic hepatitis B are often a drop incirculating HBV DNA below detection level, clearance ofHBeAg, seroconversion from HBeAg to correspondinganti-HBe antibodies, and normalization in serum ALT.* Correspondence: doczhaopan@126.com; mupanda2003@yahoo.com.cn1 Therapy and Research Center for Liver Failure, Beijing 302 Hospital, Beijing100039, PR ChinaFull list of author information is available at the end of the articleZhao et al. Virology Journal 2011, 8:75http://www.virologyj.com/content/8/1/75© 2011 Zhao et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.
