Tenofovir Versus Entecavir for the Treatment of Acute-on-Chronic Liver Failure due to Reactivation of Chronic Hepatitis B With Genotypes B and C

Background and Aims: Acute-on-chronic liver failure (ACLF) can be triggered by reactivation of chronic hepatitis B (CHB). Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) are now the most potent antiviral agents for CHB. This study aimed to compare the short-term safety and efficacy of TDF with ETV in the treatment of ACLF due to reactivation of CHB [hepatitis B virus (HBV)-ACLF]. Patients and Methods: In total, 67 consecutive patients with HBV-ACLF were divided into TDF group (n=32) receiving daily TDF (300 mg/d) and ETV group (n=35) receiving daily ETV (0.5 mg/d). They were prospectively followed-up and the primary endpoint was overall survival at 3 months. Results: At 2 weeks, the TDF group had significantly higher HBV-DNA reduction ( P =0.003), lower HBV-DNA level ( P =0.001), higher rate of HBV-DNA undetectbility ( P =0.007), lower Child-Turcotte-Pugh (CTP; P =0.003), and model for end-stage liver disease ( P =0.002) scores than the ETV group. At 3 months, HBV-DNA was undetectable in all survived patients; CTP ( P =0.970) and model for end-stage liver disease ( P =0.192) scores were comparable between the 2 groups, but markedly lower than at baseline ( P <0.01); the TDF group had significantly higher cumulative survival rate than the ETV group ( P =0.025). The white blood cell count (hazard ratio, 2.726; 95% confidence interval, 2.691-7.897; P =0.000), and HBV-DNA reduction (hazard ratio, 0.266; 95% confidence interval, 0.033-0.629; P =0.013) at 2 weeks were independent predictors for mortality. Both drugs were well tolerated. Conclusions: The short-term efficacy of TDF was superior to ETV for the treatment of HBV-ACLF. The white blood cell count and HBV-DNA reduction at 2 weeks were independent predictors for mortality at 3 months.