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Comparison of entecavir and lamivudine in preventing HBV reactivation in lymphoma patients undergoing chemotherapy: a meta-analysis

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Abstract

Background Multiple studies have compared the efficacy of entecavir with lamivudine in preventing hepatitis B virus (HBV) reactivation among HBV-carrying lymphoma patients with chemotherapy treatment. However, the results were slightly varied. Aim of the review to combine the findings of independent studies assessing the clinical efficacy of the two drugs using a systematic review and meta-analysis. Methods PubMed, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chongqing VIP and WanFang Data were retrieved. Two independent reviewers evaluated the study eligibility and extracted eight studies, with 770 patients in total. The meta-analysis was conducted using RevMan 5.3 and STATA software. Results HBV-carrying lymphoma patients receiving lamivudine during chemotherapy had a statistically significantly higher odds of HBV reactivation compared to those receiving entecavir (OR 5.0, 95 % CI 2.85–8.78, P < 0.001). The odds of hepatitis, HBV-Reactivation caused hepatitis and chemotherapy disruption was statistically significantly elevated in the patient group receiving lamivudine compared to the entecavir group (OR 4.12, 95 % CI 1.70–9.98, P = 0.002; OR 11.44, 95 % CI 2.70–48.52, P < 0.001; OR 6.71, 95 % CI 2.34–19.26, P < 0.001, respectively). Furthermore, the HBV reactivation rate in Ann Arbor stages I - II patient group was statistically significantly lower than the one in Ann Arbor stages III–IV group, with an overall pooled value of 0.37 (95 % CI 0.17–0.82, P = 0.01). Conclusion The metaanalysis result suggested that among HBV-carrying lymphoma patients undergoing chemotherapy, entecavir is more effective than lamivudine in preventing HBV reactivation.

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Acknowledgments

We thank Pan ML and Luis AP from the University of Texas Health Science Center for its linguistic assistance during the preparation of this manuscript and the reviewers for their intellectual support.

Funding

No special funding was received for this review.

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    Authors and Affiliations

    1. Department of Medical Oncology, Sichuan Cancer Hospital and Institute, No 55, Sect. 4, South People’s Road, Chengdu, 610041, Sichuan, People’s Republic of China

      Sisi Yu, Zhujuan Xiong & Zhihui Zhang

    2. Department of Clinical Laboratory, Sichuan Cancer Hospital and Institute, Chengdu, Sichuan, People’s Republic of China

      Huaichao Luo

    3. Department of Biostatistics, The University of Texas Health Science Center at Houston, Houston, USA

      Meiling Pan

    4. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, USA

      Angel Palomino Luis

    5. Health Management Center, Hospital of University of Electronic Science and Technology of China and Sichuan Provincial People’s Hospital, Chengdu, Sichuan, People’s Republic of China

      Pin Shuai

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    Sisi Yuand and Huaichao Luo have contributed equally to this work.

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    11096_2016_358_MOESM1_ESM.tif

    Supplementary Fig. 1 Funnel plot analysis for publication bias (A) Funnel plot for HBV reactivation rate (the lamivudine prophylaxis group vs. entecavir prophylaxis group) with all 8 studies, P for publication bias is 0.108; (B) Funnel plot for the incidence of hepatitis (the lamivudine prophylaxis group vs. entecavir prophylaxis group), P for publication bias is 1.00; (C) Funnel plot for the incidence of hepatitis due to HBV reactivation (the lamivudine prophylaxis group vs. entecavir prophylaxis group), P for publication bias is 0.296 (TIFF 280 kb)

    11096_2016_358_MOESM2_ESM.tif

    Supplementary Fig. 2 Funnel plot analysis for publication bias (A) Funnel plot for the incidence of chemotherapy disruption (the lamivudine prophylaxis group vs. entecavir prophylaxis group), P for publication bias is 0.296; (B) Funnel plot for HBV reactivation rate (Ann Arbor stage I–II group vs. Ann Arbor stage III–IV group), P for publication bias is 0.734 (TIFF 20526 kb)

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    Yu, S., Luo, H., Pan, M. et al. Comparison of entecavir and lamivudine in preventing HBV reactivation in lymphoma patients undergoing chemotherapy: a meta-analysis. Int J Clin Pharm 38, 1035–1043 (2016). https://doi.org/10.1007/s11096-016-0358-6

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