Background:Chronic hepatitis B(CHB)patients who had exposed to lamivudine(LAM)and telbivudine(LdT)had high risk of developing entecavir(ETV)-resistance after long-term treatment.We aimed to conduct a systematic review...Background:Chronic hepatitis B(CHB)patients who had exposed to lamivudine(LAM)and telbivudine(LdT)had high risk of developing entecavir(ETV)-resistance after long-term treatment.We aimed to conduct a systematic review and a network meta-analysis on the efficacy and cost-effectiveness on antiviral regimens in CHB patients with ETV-resistance.Data sources:We searched PubMed,EMBASE and Web of Science for studies on nucleos(t)ide analogues(NAs)treatment[including tenofovir disoproxil fumarate(TDF)-based rescue therapies,adefovir(ADV)-based rescue therapies and double-dose ETV therapy]in CHB patients with ETV-resistance.The network meta-analysis was conducted for 1-year complete virological response(CVR)and biological response(BR)rates using GeMTC and ADDIS.A cost-effective analysis was conducted to select an economic and effective treatment regimen based on the 1-year CVR rate.Results:A total of 6 studies were finally included in this analysis.The antiviral efficacy was estimated.On network meta-analysis,the 1-year CVR rate in ETV-TDF[odds ratio(OR)=22.30;95%confidence interval(CI):2.78-241.93],LAM-TDF(OR=70.67;95%CI:5.16-1307.45)and TDF(OR=16.90;95%CI:2.28-186.30)groups were significantly higher than that in the ETV double-dose group;the 1-year CVR rate in the LAM-TDF group(OR=14.82;95%CI:1.03-220.31)was significantly higher than that in the LAM/LdTADV group.The 1-year BR rate of ETV-TDF(OR=28.68;95%CI:1.70-1505.08)and TDF(OR=21.79;95%CI:1.43-1070.09)therapies were significantly higher than that of ETV double-dose therapy.TDFbased therapies had the highest possibility to achieve the CVR and BR at 1 year,in which LAM-TDF combined therapy was the most effective regimen.The ratio of cost/effectiveness for 1-year treatment was 8526,17649,20651 Yuan in the TDF group,TDF-ETV group,and ETV-ADV group,respectively.Conclusions:TDF-based combined therapies such as ETV-TDF and LAM-TDF therapies were the first-line treatment if financial condition is allowed.展开更多
To the E ditor:Acute kidney injury(AKI)is a common complication in patients with liver cirrhosis and with a high mortality[1];early diagnosis and treatment improve survival.Lipocalin 2(NGAL)and cystatin C have been id...To the E ditor:Acute kidney injury(AKI)is a common complication in patients with liver cirrhosis and with a high mortality[1];early diagnosis and treatment improve survival.Lipocalin 2(NGAL)and cystatin C have been identified as early biomarkers of AKI.However,controversy remains regarding the utility of NGAL and cystatin C for the early diagnosis of AKI in patients with liver cirrhosis.This study aimed to evaluate the performance of NGAL and cystatin C in diagnosing AKI in patients with liver cirrhosis and predicting their clinical outcomes.展开更多
基金This work was supported by a grant from the National Scientific and Technological Major Project of China(No.2017ZX10105001).
文摘Background:Chronic hepatitis B(CHB)patients who had exposed to lamivudine(LAM)and telbivudine(LdT)had high risk of developing entecavir(ETV)-resistance after long-term treatment.We aimed to conduct a systematic review and a network meta-analysis on the efficacy and cost-effectiveness on antiviral regimens in CHB patients with ETV-resistance.Data sources:We searched PubMed,EMBASE and Web of Science for studies on nucleos(t)ide analogues(NAs)treatment[including tenofovir disoproxil fumarate(TDF)-based rescue therapies,adefovir(ADV)-based rescue therapies and double-dose ETV therapy]in CHB patients with ETV-resistance.The network meta-analysis was conducted for 1-year complete virological response(CVR)and biological response(BR)rates using GeMTC and ADDIS.A cost-effective analysis was conducted to select an economic and effective treatment regimen based on the 1-year CVR rate.Results:A total of 6 studies were finally included in this analysis.The antiviral efficacy was estimated.On network meta-analysis,the 1-year CVR rate in ETV-TDF[odds ratio(OR)=22.30;95%confidence interval(CI):2.78-241.93],LAM-TDF(OR=70.67;95%CI:5.16-1307.45)and TDF(OR=16.90;95%CI:2.28-186.30)groups were significantly higher than that in the ETV double-dose group;the 1-year CVR rate in the LAM-TDF group(OR=14.82;95%CI:1.03-220.31)was significantly higher than that in the LAM/LdTADV group.The 1-year BR rate of ETV-TDF(OR=28.68;95%CI:1.70-1505.08)and TDF(OR=21.79;95%CI:1.43-1070.09)therapies were significantly higher than that of ETV double-dose therapy.TDFbased therapies had the highest possibility to achieve the CVR and BR at 1 year,in which LAM-TDF combined therapy was the most effective regimen.The ratio of cost/effectiveness for 1-year treatment was 8526,17649,20651 Yuan in the TDF group,TDF-ETV group,and ETV-ADV group,respectively.Conclusions:TDF-based combined therapies such as ETV-TDF and LAM-TDF therapies were the first-line treatment if financial condition is allowed.
基金supported by a grant from the National Scientific and Technological Major Project of China(No.2017ZX10105001)。
文摘To the E ditor:Acute kidney injury(AKI)is a common complication in patients with liver cirrhosis and with a high mortality[1];early diagnosis and treatment improve survival.Lipocalin 2(NGAL)and cystatin C have been identified as early biomarkers of AKI.However,controversy remains regarding the utility of NGAL and cystatin C for the early diagnosis of AKI in patients with liver cirrhosis.This study aimed to evaluate the performance of NGAL and cystatin C in diagnosing AKI in patients with liver cirrhosis and predicting their clinical outcomes.
