Lower risk of hepatocellular carcinoma among patients with chronic hepatitis B treated with tenofovir than entecavir

Objective: Entecavir and tenofovir may have comparableefficacy in achieving surrogate endpoints, and arerecommended as first-line treatments for patients with chronichepatitis B (CHB). However, data regarding whether they haveequivalent impacts on the risk of hepatocellular carcinoma(HCC) and mortality in CHB patients are sparse. Methods: We performed a historical cohort study with a totalof 2,726 treatment-naive adult CHB patients who consecutivelyinitiated treatment with entecavir (n = 1,567) or tenofovirdisoproxil fumarate (TDF; n = 1,159) at a tertiary referralhospital in Korea from 2010 through 2016. Data were collectedfrom the patients for up to 4 years, and we analyzed the riskof HCC and death/transplantation. Results: During 8,147 person-years of follow-up, 149 (5.5%)patients developed HCC, and 104 (3.8%) died or receivedliver transplantation. Multivariable proportional hazards modelshowed that, compared with entecavir, TDF was associated witha significantly lower HCC risk [hazard ratio (HR), 0.64; P = 0.02],but not a significantly different risk of death/transplantation(HR, 0.71; P = 0.16). TDF was consistently associated witha significantly lower HCC risk among 874 propensity scorematchedpairs (annual HCC incidence rate, 2.36% for entecavirvs. 1.34% for TDF; HR, 0.59; P = 0.01), following adjustmentwith inverse probability treatment weighting (HR, 0.65; P = 0.03),and by competing risk analysis (HR, 0.60; P = 0.02). In 517matched pairs of patients with cirrhosis, the risk of HCC wassignificantly lower with TDF than that with entecavir (HR, 0.68;P = 0.04). Conclusions: In a historical cohort of patients with CHB, TDF was associated with a significantly lower HCC riskthan entecavir, especially when the patients had cirrhosis atbaseline. DOI: 10.20892/j.issn.2095-3941.2018.S025