Tenofovir is superior to entecavir for achieving complete viral suppression in HBeAg-positive chronic hepatitis B patients with high HBV DNA

Background Entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are the two first-line anti-viral therapies for chronic hepatitis B (CHB); however, there are limited studies directly comparing their effectiveness. Aim To compare the effectiveness of ETV and TDF in nucleos(t)ide-naive CHB patients with high hepatitis B virus (HBV) DNA levels, defined as serum HBV DNA greater than 6 log(10)IU/mL. Methods We performed a retrospective multicentre cohort study of adult CHB patients who were seen between 2009 and 2012 at four Northern California community gastroenterology and hepatology clinics. Results We identified 59 consecutive patients treated with TDF and 216 patients treated with ETV. Pre-treatment characteristics were similar between the two groups. Among HBeAg-negative patients, there was no significant difference in viral suppression rates between ETV and TDF (P=0.72). In contrast, among HBeAg-positive patients, those treated with TDF achieved viral suppression significantly more rapidly than those treated with ETV (P<0.0001); the Kaplan-Meier estimated probability of complete suppression was 18% vs. 11% at 6months, 51% vs. 28% at 12months and 72% vs. 39% at 18months respectively. Multivariate Cox proportional hazards analysis indicated that treatment with TDF compared to ETV was a significant predictor of viral suppression, but only for HBeAg-positive patients (HR=2.59; 95% CI 1.58-4.22; P<0.001). Conclusion Tenofovir is significantly more effective than entecavir for achieving complete viral suppression in HBeAg-positive, nucleos(t)ide-naive chronic hepatitis B patients with HBV DNA greater than 6 log(10)IU/mL.