TDF and its analogs have not survival advantage over entecavir for patients with Hepatitis B Virus-Associated Acute-on-Chronic Liver Failure

Background: Both entecavir and tenofovir are frequently prescribed for HBV-ACLF, however, their comparative efficacy were not fully clarified. The study aimed to compare the survival, virological and liver function response between patients with entecavir and tenofovir and its analogs. Methods: We retrospectively analyzed 534 patients with HBV-ACLF who were given either entecavir (n= 115) or tenofovir and its analogs (n= 102) in a single medical center in China. The primary endpoints were 28-day and 90-day liver-transplantation-free mortality. Secondary outcomes were changes of serum HBV-DNA and MELD scores. Results: Over 90-day follow-up, 20.9% died in patients with entecavir, and 11.8% in those with tenofovir and its analogs. The cumulative liver-transplantation-free survival rates were similar between the two groups ( 18.2% and 22.2% for 28-day and 90-day mortality in entecavir group; 5.1% and 12.2% for 28-day and 90-day mortality in tenofovir group, respectively, P= 0.003, and 0.060, respectively). In the multivariate Cox proportional hazard analysis adjusting age, cirrhosis, hepatic encephalopathy, ascites, MELD scores, serum HBV-DNA levels and sex, the types of antivirals was not associated to the 90-day mortality (HR: 0.691, 95% CI: 0.337 to 1.42, P=0.314)(entecavir as the reference). The main findings were consistent with that after PSM or by competing risk model. Beside, the decline of serum HBV-DNA levels and improvement of MELD scores were also comparable between the two groups. Conclusion: There was no significant difference in the efficacy of entecavir and tenofovir and analogs in treating patients with HBV-ACLF. There findings suggest both entecavir and tenofovir and its analogs can serve as first-line antivirals for HBV-ACLF.