Efficacy and Safety of Telbivudine Combined with Adefovir Dipivoxil for Chronic Hepatitis B: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHANGKai ^1,2 , LIZheng ^1,3 ,  CHENHong ^1,2

1. The First Clinical Medicine College of Lanzhou University, Lanzhou 730000, China;
2. Department of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou 730000, China;
3. Evidence Based Medicine Center of Lanzhou University, Lanzhou 730000, China;

Corresponding?author：

CHENHong, Email: chenhong1956@126.com

Keywords：

Chronic hepatitis B; Telbivudine; Adefovir dipivoxil; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140057

Video：

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Objective To evaluate the clinical efficacy and safety of telbivudine (TEV) combined with adefovir dipivoxil (ADV) for chronic hepatitis B (CHB), so as to provide references for clinical practice and research. Methods We electronically searched databases including The Cochrane Library (Issue 7, 2013), PubMed, EMbase, Web of Science, CBM, CNKI, VIP, and WanFang Data from inception to August 21st, 2013, for the relevant randomized controlled trials (RCTs). Other sources were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results A Total of 11 RCTs involving 1 010 patients were included. The trial group were given TEV combined with ADV, while the control group were given TEV alone or ADV alone. The results of metaanalysis showed that, the combined use was superior to TEV alone or ADV alone in improving HBV-DNA negative rates at 12-, 24-, 48-weeks, HBeAg negative rates at 12-, 24-, 48-weeks, and ALT recovery rates at 12-, 24-weeks (P < 0.05). The results of qualitative analysis showed that, the trial group had a lower drug resistance rate, and both were alike in the incidence of adverse reaction. Conclusion Compared with TEV alone or ADV alone, TEV combined with ADV could improve the clinical efficacy of treating CHB which is also fairly safe. Due to the limited quantity and quality of the included studies, the aforementioned conclusion still needs to be further verified by conducting more large-scale and high quality RCTs.

Citation： ZHANGKai, LIZheng, CHENHong. Efficacy and Safety of Telbivudine Combined with Adefovir Dipivoxil for Chronic Hepatitis B: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(3): 335-340. doi: 10.7507/1672-2531.20140057 Copy

1.	?趙樹山, 范學工, 陳立章, 等.阿德福韋酯聯合胸腺肽α-1與單用阿德福韋酯比較治療慢性乙肝的系統評價.中國循證醫學雜志, 2010, 10(8):972-977.
2.	毛海鷹, 康濤, 邱邦東, 等.拉米夫定聯合阿德福韋酯治療失代償期乙型肝炎肝硬化療效的系統評價.中國藥房, 2013, 24(24):2270-2274.
3.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.Cochrane-handbook.org.
4.	Chan HL, Heathcote EJ, Marcellin P, et al. Treatment of hepatitis B e antigen positive chronic Hepatitis with telbivudine or adefovir:a randomized trial. Ann Intern Med, 2007, 147(11):745-754.
5.	程丹, 陳炎生, 劉文濤, 等.加用或換用阿德福韋酯治療替比夫定耐藥的慢性乙型肝炎療效比較.肝臟, 2013, 18(1):36-38.
6.	黃斌.聯合用藥治療耐藥型乙型肝炎的臨床療效.當代醫學, 2013, 19(3):138-139.
7.	黃建偉, 秦愛蘭, 徐天敏.替比夫定單用與聯合阿德福韋酯治療HBeAg陽性慢性乙型肝炎48周療效觀察.肝臟, 2013, 18(4):231-233.
8.	楊永銳, 李暉, 高斯媛, 等.替比夫定聯合阿德福韋酯治療HBeAg陽性慢乙肝臨床觀察.昆明醫科大學學報, 2013, 34(1):109-111.
9.	郜英, 宋茂舟, 麻莉.替比夫定治療對阿德福韋酯應答不佳慢性乙型肝炎患者的效果觀察.中國當代醫藥, 2012, 19(36):68-69.
10.	王秀英.替比夫定聯合阿德福韋酯治療出現病毒變異的慢性乙型肝炎25例.中國藥業, 2012, 21(21):98-99.
11.	賀小平.替比夫定與阿德福韋酯治療慢性乙肝對肝功能、免疫學的影響分析.健康必讀(中旬刊), 2011, 11(12):50-51.
12.	李愛芝, 高研.替比夫定聯合阿德福韋酯治療阿德福韋酯耐藥的慢性乙型肝炎療效觀察.國際流行病學傳染病學雜志, 2011, 38(5):301-303.
13.	權耀生.替比夫定聯合阿德福韋酯治療HBeAg陽性慢性乙型肝炎療效觀察.中國醫藥指南, 2011, 9(36):134-136.
14.	吳杭源, 華忠, 尤德宏, 等.替比夫定治療慢性乙型肝炎出現病毒變異聯用阿德福韋酯治療的臨床觀察.現代中西醫結合雜志, 2011, 20(30):3791-3793.
15.	朱深勤, 周祥富, 巫翠萍.替比夫定聯合阿德福韋酯治療慢性乙型肝炎療效觀察.中國熱帶醫學, 2010, 10(10):1231-1232.
16.	Ganem D, Prince AM. Hepatitis B virus infection--natural history and clinical consequences. N Engl J Med, 2004, 350(11):1118-1129.
17.	賈繼東, 李蘭娟.慢性乙型肝炎防治指南(2010年版).臨床肝膽病雜志, 2011, 27(1):113-128.
18.	Lu FM, Zhuang H. Management of hepatitis B in China. Chin Med J(Engl), 2009, 122(1):3-4.
19.	曹創杰, 杜文軍, 竇橙云, 等.替比夫定治療初治慢性乙型肝炎患者T淋巴細胞亞群的變化與早期應答的關系.中華傳染病雜志, 2012, 30(3):170-174.
20.	Seifer M, Patty A, Serra I, et al. Telbivudine, a nucleoside analog inhibitor of HBV polymerase, has a different in vitro cross-resistance profile than the nucleotide analog inhibitors adefovir and tenofovir. Antiviral Res, 2009, 81(2):147-155.
21.	徐慶杰, 粱智剛, 和振坤.拉米夫定聯合阿德福韋酯治療拉米夫定耐藥慢性乙型肝炎患者48周的療效.中華肝臟病雜志, 2010, 18(7):540-541.

1. ?趙樹山, 范學工, 陳立章, 等.阿德福韋酯聯合胸腺肽α-1與單用阿德福韋酯比較治療慢性乙肝的系統評價.中國循證醫學雜志, 2010, 10(8):972-977.
2. 毛海鷹, 康濤, 邱邦東, 等.拉米夫定聯合阿德福韋酯治療失代償期乙型肝炎肝硬化療效的系統評價.中國藥房, 2013, 24(24):2270-2274.
3. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.Cochrane-handbook.org.
4. Chan HL, Heathcote EJ, Marcellin P, et al. Treatment of hepatitis B e antigen positive chronic Hepatitis with telbivudine or adefovir:a randomized trial. Ann Intern Med, 2007, 147(11):745-754.
5. 程丹, 陳炎生, 劉文濤, 等.加用或換用阿德福韋酯治療替比夫定耐藥的慢性乙型肝炎療效比較.肝臟, 2013, 18(1):36-38.
6. 黃斌.聯合用藥治療耐藥型乙型肝炎的臨床療效.當代醫學, 2013, 19(3):138-139.
7. 黃建偉, 秦愛蘭, 徐天敏.替比夫定單用與聯合阿德福韋酯治療HBeAg陽性慢性乙型肝炎48周療效觀察.肝臟, 2013, 18(4):231-233.
8. 楊永銳, 李暉, 高斯媛, 等.替比夫定聯合阿德福韋酯治療HBeAg陽性慢乙肝臨床觀察.昆明醫科大學學報, 2013, 34(1):109-111.
9. 郜英, 宋茂舟, 麻莉.替比夫定治療對阿德福韋酯應答不佳慢性乙型肝炎患者的效果觀察.中國當代醫藥, 2012, 19(36):68-69.
10. 王秀英.替比夫定聯合阿德福韋酯治療出現病毒變異的慢性乙型肝炎25例.中國藥業, 2012, 21(21):98-99.
11. 賀小平.替比夫定與阿德福韋酯治療慢性乙肝對肝功能、免疫學的影響分析.健康必讀(中旬刊), 2011, 11(12):50-51.
12. 李愛芝, 高研.替比夫定聯合阿德福韋酯治療阿德福韋酯耐藥的慢性乙型肝炎療效觀察.國際流行病學傳染病學雜志, 2011, 38(5):301-303.
13. 權耀生.替比夫定聯合阿德福韋酯治療HBeAg陽性慢性乙型肝炎療效觀察.中國醫藥指南, 2011, 9(36):134-136.
14. 吳杭源, 華忠, 尤德宏, 等.替比夫定治療慢性乙型肝炎出現病毒變異聯用阿德福韋酯治療的臨床觀察.現代中西醫結合雜志, 2011, 20(30):3791-3793.
15. 朱深勤, 周祥富, 巫翠萍.替比夫定聯合阿德福韋酯治療慢性乙型肝炎療效觀察.中國熱帶醫學, 2010, 10(10):1231-1232.
16. Ganem D, Prince AM. Hepatitis B virus infection--natural history and clinical consequences. N Engl J Med, 2004, 350(11):1118-1129.
17. 賈繼東, 李蘭娟.慢性乙型肝炎防治指南(2010年版).臨床肝膽病雜志, 2011, 27(1):113-128.
18. Lu FM, Zhuang H. Management of hepatitis B in China. Chin Med J(Engl), 2009, 122(1):3-4.
19. 曹創杰, 杜文軍, 竇橙云, 等.替比夫定治療初治慢性乙型肝炎患者T淋巴細胞亞群的變化與早期應答的關系.中華傳染病雜志, 2012, 30(3):170-174.
20. Seifer M, Patty A, Serra I, et al. Telbivudine, a nucleoside analog inhibitor of HBV polymerase, has a different in vitro cross-resistance profile than the nucleotide analog inhibitors adefovir and tenofovir. Antiviral Res, 2009, 81(2):147-155.
21. 徐慶杰, 粱智剛, 和振坤.拉米夫定聯合阿德福韋酯治療拉米夫定耐藥慢性乙型肝炎患者48周的療效.中華肝臟病雜志, 2010, 18(7):540-541.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Telbivudine Combined with Adefovir Dipivoxil for Chronic Hepatitis B: A Systematic Review

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