Comparing the Efficacy and Safety of Treating Chronic Hepatitis B Infection During Pregnancy With Lamivudine, Telbivudine, and Tenofovir: A Meta-Analysis Publisher



Sali S¹ ; Darvishi M² ; Ghasemiadl M³ ; Akhlaghdoust M⁴ ; Mirzazadeh A⁵ ; Behjati SE⁶ ; Sheikhzeinolabedini H⁶ ; Shokouhi S¹ ; Tavakolpour S^{1, 3}
Source: Journal of Clinical and Translational Hepatology Published:2019

Abstract

Background and Aims: The perinatal transmission of hepatitis B virus (HBV) remains an important global health prob-lem. Here, a systematic review and meta-analysis were conducted to evaluate the evidence regarding the efficacy and maternal/fetal safety of treating pregnant women with lamivudine, telbivudine (LdT), and tenofovir (TDF). Methods: A PubMed and Scopus search resulted in 1,076 records, which were reduced to 36, containing 7,717 pregnant women with chronic HBV infection and 7467 infants meeting the inclusion criteria. The latest search was in August 2019. Results: Treatment with LdT, but not lamivudine and TDF, could significantly reduce the hepatitis B virus surface antigen-positive rate (odds ratio (OR) = 0.37) in infants; it also led to higher rates of hepatitis B e antigen loss (OR = 12.14), hepatitis B e antigen seroconversion (OR = 8.93), and alanine aminotransferase normalization in mothers (OR = 1.49). Each of these treatments was able to significantly reduce HBV DNA positivity at birth (total OR = 0.19) and mother-to-child-transmission of HBV (total OR = 0.15), and to cause higher rates of HBV DNA suppression in mothers (total OR = 25.53). However, nucleos(t)ide analogues might also be involved in creatine kinase elevation (total OR = 7.48). In contrast, no significant association was found between nucleos(t)ide analogue therapy and pre-term/premature births, congenital malformation, low birth weight, and abortion or fetal/infant death. The results sug- gested LdT’s high capability of preventing mother-to-child-transmission. However, TDF failed to show significant associ-ations to a reduced risk of mother-to-child-transmission, probably due to the low number of patients included. Con-clusions: Although using either lamivudine, LdT, or TDF could lead to more favorable maternal/fetal outcomes, LdT seemed to show more potential in resolving certain infant-and mater-nal-related outcomes. More studies on the safety profile of such treatments are required. Citation of this article: Sali S, Darvishi M, GhasemiAdl M, Akhlaghdoust M, Mirzazadeh A, Behjati SE, et al. Comparing the efficacy and safety of treating chronic hepatitis B infection during pregnancy with lamivudine, telbivudine, and tenofovir: A meta-analysis. © 2019 Authors.