Entecavir versus tenofovir

The cumulative probabilities of hepatocellular carcinoma
(HCC), death, or liver transplant were studied in 2,897 treatment-
naïve patients with hepatitis B who started treatment
with either entecavir (ETV) or tenofovir deoxyfumarate (TDF)
between 2012 and 2014. The patients were recruited from 4
academic centers in South Korea. Patients with decompensated
cirrhosis, HCC, or coinfection with other hepatitis viruses
were excluded. 33.6 % of the patients had compensated cirrhosis
at baseline in the entecavir arm compared to 29.1% in the TDF
arm and the TDF group had a higher baseline platelet count
(173.1 vs 165.6 x 103/μL). The proportion of males was higher
in the TDF arm (64.6 % vs 59.9%) and the HBV-DNA level was
lower (5.4 vs 5.7 log10). Among the entire cohort 240 patients
(8.3%) developed HCC, 138 in the ETV group and 102 in the
TDF group. The difference was not statistically significant. The
risks of death or liver transplant were not significantly different
between the groups. A propensity score analysis generated
1,278 pairs without any statistically differences between TDF
and ETV for HCC, death or transplant.

Ref; Kim et al. J Hepatology 2019;71:45-464

Comment: An earlier study from South Korea indicated an increased
risk for HCC with ETV compared to TDF treatment.
These findings were not confirmed in the present study. Hopefully
future study results will shed light on and explain the different
results from the two studies. In the meantime it seems reasonable
to recommend both drugs for the treatment of chronic
hepatitis B.