| Objective: To compare the efficacy and safety of nucleos(t)ide analogue monotherapy for treatment of naive patients with chronic hepatitis B.The drugs include telbivudine,entecavir,lamivudine,tenofovir,adefovir.Methods: A systematic review of PubMed,Cocrhane Library,EMBase,Web of Science,Wanfang Database,VIP database was conducted to identify all studies evaluating the efficacy and safety of these nucleos(t)ides in adults with chronic hepatitis B(CHB).Only randomized controlled trials were included.The evaluated outcomes included undetectable HBV DNA,ALT normalization,HBeAg loss and HBeAg seroconversion,all at 1 year.We used the computer software Stata13 to perform this network meta-analysis.We used fixed effects model,and the effect-size indice was risk ratio(RR).Results: 14 randomized controlled clinical trials were included in the network meta-analysis,containing a total number of 5720 adults diagnosed with chronic hepatitis B.Tenofovir had the best results for undectable HBV DNA,but when compared to entecavir and tebivudine,the difference was not statistically significant.Differences between the five nucleos(t)ides for ALT normalization,HBeAg loss and HBeAg seroconversion were not statistically significant.And the frequency of adverse events was similar between five nucleos(t)ides as well.After 1 year of treatment,entecavir and tenofovir didn't develop drug resistance.Drug resistance rate of telbivudine was between 2.3% and 6.67%,drug resistance rate of lamivudine was between 1.78% and 15.24%,drug resistance rate of adefovir was between 1.86% and 8.08%.Conclusion:In naive patients with CHB after 1 year of treatment,TDF had the best results for undectable HBV DNA.ETV had the best results for ALT normalization.LdT had the best results for HBeAg loss and HBeAg seroconversion.The frequency of adverse events was similar between five nucleos(t)ides.No resistance was developed in entecavir and tenofovir.But telbivudine,lamivudine,adefovir developed drug resistance. |
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