Author/Authors :
zhang, yaxiong sun yat-sen university - zhongshan school of medicine, Guangzhou, China , kang, shiyang sun yat-sen university - zhongshan school of medicine, Guangzhou, China , fang, wenfeng sun yat-sen university - cancer center - department of medical oncology, Guangzhou, China , fang, wenfeng collaborative innovation center for cancer medicine, Guangzhou, China , wu, xuan sun yat-sen university - cancer center - department of medical oncology, Guangzhou, China , wu, xuan collaborative innovation center for cancer medicine, Guangzhou, China , liang, wenhua collaborative innovation center for cancer medicine, Guangzhou, China , liang, wenhua sun yat-sen university - cancer center - department of medical oncology, Guangzhou, China
Abstract :
Background: Previous meta-analyses of non-randomized studies suggested that the hepatitis Bimmunoglobulin (HBIG) and lamivudine (LAM) combination therapy was significantly better than HBIGor LAM alone in preventing hepatitis B virus (HBV) recurrence after transplantation. However, substantialevidences supporting the superiority of combination therapy are still insufficient. Therefore, we soughtto conduct a multiple-treatment comparison to integrate current data which was based on randomizedcontrolled trials (RCTs).Methods: We searched electronic databases of PubMed, Embase and the Cochrane Library for eligibleliteratures. Pair-wise meta-analyses were to synthesize studies comparing the same pair of treatments.Appropriate networks for overall and 1-year recurrence rates were established. Bayesian algorithm was usedin multiple-treatment comparisons to compare relative effects of all included regimens.Results: Four RCTs on prophylaxis against HBV recurrence after liver transplantation, involving 162participants, were included. HBIG mono-therapy, LAM mono-therapy and HBIG plus LAM showed nostatistically difference in risk ratios (RRs) in terms of overall HBV recurrence rate in network meta-analysis.Nevertheless, HBIG mono-therapy had potential advantage compared with combination of HBIG andLAM in 1-year HBV recurrence rate [RR 0.00, 95% confidence interval (CI): 0.00 to 0.91] while the restcomparisons revealed no significance. The cumulative probabilities of treatments associated with the highestrecurrence were (overall HBV recurrence rate, 1-year HBV recurrence rate): HBIG (18%, 1%), LAM (32%,42%) and HBIG plus LAM (50%, 57%).Conclusions: This network meta-analysis based on data from RCTs showed no significant differencesamong HBIG mono-therapy, LAM mono-therapy, combination of HBIG and LAM in overall HBVrecurrence rate after liver transplantation. Further well designed and large-scale RCTs are warranted toclarify these issues.
Keywords :
Hepatitis B , liver transplantation , hepatitis B immunoglobulin (HBIG) , lamivudine (LAM) , network meta , analysis
