Kronik Hepatit B Enfeksiyonunda Tenofovir ve Entekavir Tedavi Sonuçlarının Karşılaştırılması

Öz

Amaç: Bu çalışmada, kronik hepatit B (KHB) enfeksiyonu veya KHB ilişkili kompanse karaciğer sirozu tanısı almış hastalarda, entekavir ve tenofovir tedavilerinin uzun süreli kullanımda virolojik baskılanma, serolojik dönüşüm ve biyokimyasal parametreler üzerindeki etkileri-nin karşılaştırmalı olarak incelenmesi amaçlanmıştır. Materyal ve Metot: Bu retrospektif kohort çalışmaya, Dicle Üniversitesi Tıp Fakültesi Hastanesi Gastroenteroloji Anabilim Dalı’nda tenofovir veya entekavir tedavisi alan kronik HBV enfeksiyonlu, yalnızca kompanse sirozu olan hastalar da dahil edilmiştir. Karaciğer nakli öyküsü, dekompanse siroz, immünsupresif tedavi, gebelik ve kontrolsüz diyabet dışlama kriterleri olarak belirlenmiştir. Klinik ve labora-tuvar veriler hasta dosyalarından retrospektif olarak toplanmıştır. HBV DNA, ALT ve AST düzeyleri düzenli aralıklarla izlenmiş; serolojik belirteçler (HBsAg, anti-HBs, HBeAg, anti-HBe) ilk yıl üçer aylık aralıklarla ve devamında altı aylık periyotlarla değerlendirilmiştir. Karaciğer biyopsileri, modifiye Knodell (İshak) skorlama sistemi ile analiz edilmiş, hepatik aktivite indeksi ve fibrozis evresi kaydedilmiştir. Bulgular: Toplam 400 hasta (234 tenofovir, 166 entekavir) çalışmaya dahil edilmiştir. Gruplar, başlangıç özellikleri açısından benzerdi. Virolojik baskılanma oranları genel olarak iki grupta benzer bulunmuştur. Ancak HBeAg pozitif hastalarda 2. yılda entekavir lehine anlamlı bir fark saptanmıştır (p=0.02). HBeAg pozitif hastalar arasında ALT normalleşmesi açısından entekavir tenofovire 6. ayda (p=0.02) ancak 5. yılda ise tenofovir entakavire göre (p=0.04) daha etkili bulunmuştur. HBeAg negatif hastalarda ise 5. yılda ALT normalleşme oranı entekavir grubunda anlamlı olarak daha yüksekti (p=0.007). Biyokimyasal yanıt açısından ise entekavir grubunda 6. Ayda (p=0.016) ve 60. ayda (p=0.045) ALT düzeylerinde daha belirgin normalleşme izlenmiştir. Serolojik yanıt oranları (HBeAg serokonversiyonu ve HBsAg kaybı) iki tedavi grubu arasında farklılık göstermemiştir. Sonuç: Tenofovir ve entekavir, KHB tedavisinde benzer virolojik ve serolojik etkinlik göstermektedir. Bununla birlikte, entekavir özellik-le bazı hasta alt gruplarında ve tedavinin belirli dönemlerinde biyokimyasal yanıt açısından üstünlük sağlayabilir.

Anahtar Kelimeler

• Entekavir
• Kronik Hepatit B
• Tenofovir

Destekleyen Kurum

Bu çalışma herhangi bir fon tarafından desteklenmemiştir.

Etik Beyan

2020 yılı öncesi tıpta uzmanlık tezlerinde retrospektif çalışmalarda etik kurul onay şartı olmadığından etik kurul onayı alınmamıştır (Tıpta uzmanlık tezi tarihi 2016 ve tez numarası 440071)

Comparison of Tenofovir and Entecavir Treatment Results in Chronic Hepatitis B Infection

Öz

Background: The aim of this study is to comparatively evaluate the long-term effects of entecavir and tenofovir treatments on virologi-cal suppression, serological response, and biochemical parameters in patients diagnosed with chronic hepatitis B (CHB) infection or CHB-related compensated liver cirrhosis. Materials and Methods: This retrospective cohort study included patients with chronic HBV infection and compensated cirrhosis who received tenofovir or entecavir therapy at the Department of Gastroenterology, Dicle University Faculty of Medicine Hospital. Patients with a history of liver transplantation, decompensated cirrhosis, use of immunosuppressive therapy, pregnancy, or uncontrolled diabetes were excluded from the study. Clinical and laboratory data were retrospectively collected from patient records. HBV DNA, ALT, and AST levels were monitored at regular intervals. Serological markers (HBsAg, anti-HBs, HBeAg, and anti-HBe) were assessed quarterly during the first year and every six months thereafter. Liver biopsy specimens were evaluated using the modified Knodell (Ishak) scoring system, and both the hepatic activity index and fibrosis stage were recorded. Results: A total of 400 patients were included in the study, with 234 receiving tenofovir and 166 receiving entecavir. The two groups were similar in terms of baseline characteristics. Overall, virological suppression rates were comparable between the groups. However, among HBeAg-positive patients, a significant difference favoring entecavir was observed at the second year of treatment (p=0.02). Regarding ALT normalization in HBeAg-positive patients, entecavir was more effective than tenofovir at month 6 (p=0.02), whereas tenofovir showed greater efficacy at year 5 (p=0.04). In HBeAg-negative patients, the ALT normalization rate at year 5 was significantly higher in the entecavir group (p=0.007). In terms of biochemical response, ALT normalization was more prominent in the entecavir group at both month 6 (p=0.016) and month 60 (p=0.045). Serological response rates, including HBeAg seroconversion and HBsAg loss, did not differ significantly between the two treatment groups. Conclusion: Tenofovir and entecavir demonstrate comparable virological and serological efficacy in the treatment of chronic HBV infection. However, entecavir may offer superior biochemical response in certain patient subgroups and at specific time points during therapy.

Anahtar Kelimeler

• Chronic Hepatitis B
• Entecavir
• Tenofovir

Kaynakça

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