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Risk of Hepatocellular Carcinoma With Entecavir vs Tenofovir Treatment for Chronic Hepatitis B

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Key Points

  • Tenofovir was associated with lower incidence of HCC vs entecavir.
  • Similar findings were made in propensity score–matched analysis.

In a Korean nationwide cohort study reported in JAMA Oncology, Choi et al found that hepatocellular carcinoma (HCC) appeared to be more common with first-line entecavir vs tenofovir treatment for chronic hepatitis B.

The study involved data from the Korean National Health Insurance Service database on treatment-naive patients who started treatment with entecavir (n = 11,464) or tenofovir (n = 12,692) between January 2012 and December 2014. A separate analysis was performed in a hospital cohort of patients treated with entecavir (n = 1,560) or tenofovir (n = 1,141) in a tertiary referral center between January 2010 and December 2016.

Risk of HCC

In the population cohort, the annual incidence rate of HCC was 0.64 per 100 person-years in the tenofovir group vs 1.06 per 100 person-years in the entecavir group. On multivariate analysis, patients receiving tenofovir had a lower risk of HCC (hazard ratio [HR] = 0.61, P < .001), as well as a lower risk of the composite outcome of annual risk of all-cause mortality or transplantation (HR = 0.77, P = .004).

Tenofovir treatment was also associated with a lower risk of HCC in the hospital validation cohort (HR = 0.66, P = .03). In propensity score–matched analyses, tenofovir was associated with a lower risk of HCC in both the population cohort (HR = 0.62, P < .001) and the hospital validation cohort (HR = 0.68, P = .04).

The investigators concluded, “This study suggests that tenofovir treatment was associated with a significantly lower risk of HCC compared with entecavir treatment in a population-based cohort of adults with [chronic hepatitis B]; these findings were validated in a hospital cohort. Given the poor prognosis of patients with HCC, these findings may have considerable clinical implications in prevention of this cancer in patients with [chronic hepatitis B] infection.”

The study was supported by the National Research Foundation of Korea, Korean Health Technology R&D Project, Ministry of Health &Welfare, and Korean Gastroenterology Fund for Future Development.

Young-Suk Lim, MD, PhD, of the Asan Medical Center, University of Ulsan College of Medicine, and Jung Ko, PhD, of the National Evidence-Based Healthcare Collaborating Agency, Seoul, are the corresponding authors for the JAMA Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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