ArticleInfectious diseases and therapy2025
Efficacy and Safety of Entecavir, Tenofovir Disoproxil Fumarate, and Tenofovir Alafenamide Fumarate in Treating Acute-on-Chronic Liver Failure with Hepatitis B Virus: A Network Meta-analysis.
Article in Infectious diseases and therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Review Article: Renal Safety Profiles of Tenofovir Alafenamide, Tenofovir Disoproxil Fumarate, and Entecavir for the Treatment of Chronic Hepatitis B Infection-General and Special Populations.Alimentary pharmacology & therapeutics · 2026Review
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4 authors.
Funding
Abstract
introductionOral nucleos(t)ide analogues (NAs) are widely used in managing hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). Among first-line therapies, entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF) are commonly prescribed. However, their comparative efficacy and safety remain unclear in HBV-ACLF.
methodsWe performed a systematic search of PubMed, Embase, Cochrane Library, and Web of Science up to January 2025 for studies evaluating ETV, TDF, and TAF in HBV-ACLF. The data were analyzed using standardized mean differences (SMD), 95% confidence intervals (95% CI), and surface under the cumulative ranking curve (SUCRA).
resultsNine studies (five prospective, four retrospective) were included. TDF significantly improved 12-week survival compared to ETV (SMD = - 0.21; 95% CI - 0.36 to - 0.06), with no significant difference between TDF and TAF. For 12-week HBV-DNA clearance, TAF outperformed ETV (SMD = - 0.40; 95% CI - 0.77 to - 0.02), ranking highest in SUCRA (83.5%). TAF also showed superior virological suppression at 4 weeks (SUCRA: TAF 72.2% > ETV 49.1% > TDF 28.8%). TDF improved 12-week model for end-stage liver disease (MELD) scores more than ETV (SMD = 1.05; 95% CI 0.15-1.94). The drugs did not differ significantly in improving liver function at 4 weeks, as measured by alanine aminotransferase (ALT) and total bilirubin (TBIL) levels. Regarding renal function, ETV had a greater impact on the 4-week estimated glomerular filtration rate (eGFR) than TAF (SMD = - 0.35; 95% CI - 0.52 to 0.18), and both TDF and ETV showed a more significant effect on the 4-week creatinine (cr) levels than TAF (TDF: SMD = 0.29; 95% CI 0.00-0.57; ETV: SMD = 0.30; 95% CI 0.09-0.51).
conclusionsOverall, TDF and TAF provide superior survival and antiviral benefits over ETV in HBV-ACLF, with three drugs showing similar effects in improving liver function. Moreover, TAF demonstrated the most favorable profile in viral suppression and renal safety.
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