Nucleos(t)ide analogues for preventing HBV reactivation in immunosuppressed patients with hematological malignancies: a network meta-analysis

<b>Background</b>: We aimed to evaluate the efficacy of five oral nucleos(t)ide analogues (NAs), including lamivudine, entecavir, adefovir, telbivudine and tenofovir, for the prevention of hepatitis B virus (HBV) reactivation and HBV-related complications in chronic hepatitis B virus (CHB) infected patients with hematological malignancies receiving chemotherapy or hematopoietic stem cell transplantation (HSCT) by network meta-analysis. <b>Methods</b>: The search identified 28 articles involving 5 different prophylactic regimens covering 1478 participants. <b>Results</b>: Among five prophylactic regimes, tenofovir (predicted probability, 90%), was the most effective intervention followed by entecavir (88%) in preventing HBV reactivation. There was no significant difference between tenofovir and entecavir for preventing HBV reactivation. With regards to other outcomes, tenofovir and telbivudine was not included to evaluate due to lack of relevant studies. Entecavir was the most effective intervention in reducing the risk of HBV related hepatitis (100%), HBV related death (61%) and all other causes of hepatitis (98%). <b>Conclusion</b>: Tenofovir and entecavir might be the most potent regimes in prevention of HBV reactivation for CHB infected patients with hematological malignancies undergoing chemotherapy or HSCT.

**研究背景**：本研究旨在通过网络Meta分析，评估拉米夫定、恩替卡韦、阿德福韦、替比夫定与替诺福韦这5种口服核苷（酸）类似物（nucleos(t)ide analogues, NAs），在接受化疗或造血干细胞移植（hematopoietic stem cell transplantation, HSCT）的慢性乙型肝炎病毒（chronic hepatitis B virus, HBV）感染合并血液系统恶性肿瘤患者中，预防HBV再激活及HBV相关并发症的疗效。
**研究方法**：本次检索共纳入28篇文献，涉及5种不同的预防方案，共计1478名受试者。
**研究结果**：在5种预防方案中，替诺福韦（预测概率90%）是预防HBV再激活效果最佳的干预措施，其次为恩替卡韦（88%）；二者在预防HBV再激活方面无显著差异。针对其他结局指标，因缺乏相关研究，未纳入替诺福韦与替比夫定开展评估。恩替卡韦在降低HBV相关肝炎（100%）、HBV相关死亡（61%）及其他所有类型肝炎（98%）的风险方面效果最优。
**研究结论**：对于接受化疗或造血干细胞移植的慢性乙型肝炎病毒感染合并血液系统恶性肿瘤患者，替诺福韦与恩替卡韦可能是预防HBV再激活的最优方案。