Liver and Bile
J Gastroenterol Hepatol. 2022;37(1):200–7
Long-term effects of entecavir and tenofovir treatment on the fibrotic burden in patients with chronic hepatitis B
Background and aim: Antiviral therapy (AVT) induces fibrosis regression in patients with chronic hepatitis B. The authors investigated long-term effects of entecavir (ETV) versus tenofovir disoproxil fumarate (TDF) on fibrotic burden.
Methods: Treatment-naive chronic hepatitis B patients who had begun ETV or TDF were recruited from 4 tertiary hospitals. The aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on 4 factors (FIB-4) were used to determine fibrotic burden.
Results: In the entire population (n = 3277), although patients treated with ETV had higher baseline APRI (1.71 vs. 1.07, p < 0.001) and FIB-4 (3.60 vs. 2.80, p < 0.001) than those treated with TDF, significant fibrosis regression was identified during 6 years of AVT in both ETV (APRI, mean 1.71 → 0.48, p < 0.001; FIB-4, mean 3.60 → 2.21, p < 0.001) and TDF groups (APRI, mean 1.07 → 0.43, p < 0.001; FIB-4, mean 2.80 → 2.19, p < 0.001). In patients without cirrhosis (n = 2366), baseline APRI was significantly higher in the ETV group than in the TDF group (1.72 vs. 0.97, p < 0.001); however, they became similar after 6 months. Similarly, baseline FIB-4 was significantly higher in the ETV group than in the TDF group (3.25 vs. 2.35, p < 0.001), but became similar from 4 to 6 years. In patients with cirrhosis (n = 911), baseline APRI (1.70 vs. 1.34, p < 0.001) and FIB-4 (4.62 vs. 3.91, p = 0.005) were higher in the ETV group than in the TDF group, however, both parameters became statistically similar from 6 months to 6 years.
Conclusion: Significant regression of APRI and FIB-4 was observed during long-term entecavir and tenofovir disoproxil fumarate treatment. Despite higher baseline fibrotic burden in the entecavir group, fibrotic burden between the groups eventually converged through significant fibrosis regression after 1 to 4 years of antiviral therapy.