{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T22:33:40Z","timestamp":1790721220146,"version":"4.1.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T00:00:00Z","timestamp":1737331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To systematically evaluate the efficacy and safety of tenofovir and entecavir in chronic hepatitis B-related cirrhosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A comprehensive search was conducted in databases including PubMed, Web of Science, Embase and Cochrane Library from the inception until June 2024. Studies on the use of tenofovir and entecavir for chronic hepatitis B-related cirrhosis were collected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 14 studies involving 14,208 patients were included. The meta-analysis revealed that tenofovir significantly reduced the cumulative incidence of hepatocellular carcinoma and cumulative mortality compared to entecavir in East Asian popupation, while in non East Asian populations, the two groups are roughly equivalent. After 48\u00a0weeks, the hepatitis B virus-deoxyribonucleic acid clearance rate in the tenofovir group were comparable to the entecavir group. Both tenofovir and entecavir showed similar effect in reducing the incidence of hepatic encephalopathy. Compared with the entecavir group, patients in the tenofovir group, including tenofovir disoproxil fumarate and tenofovir alafenamide fumarate showed a significant increase in estimated glomerular filtration rate after 48\u00a0weeks of treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Compared to entecavir, tenofovir significantly reduced the cumulative incidence of hepatocellular carcinoma and cumulative mortality in chronic hepatitis B-related cirrhosis in East Asian population. However, both drugs were comparable in terms of hepatitis B virus-deoxyribonucleic acid clearance and hepatic encephalopathy. Tenofovir did not significantly cause renal dysfunction, but instead improved estimated glomerular filtration rate levels compared with entecavir. Randomized controlled trials with larger sample size are still needed for validation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic Review Registration<\/jats:title><jats:p><jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>, identifier CRD42024588432.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fphar.2025.1507117","type":"journal-article","created":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T07:21:40Z","timestamp":1737357700000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Efficacy and safety of tenofovir and entecavir in patients with chronic hepatitis B-related cirrhosis: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Lu","family":"Cao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixing","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"264","DOI":"10.5152\/kd.2020.54","article-title":"Entecavir and tenofovir treatment in patients with hepatitis B virus-related cirrhosis: a comparison of results of two-year treatment","volume":"33","author":"Alkan","year":"2020","journal-title":"Klimik J."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1282","DOI":"10.1007\/s12072-022-10410-y","article-title":"Countdown on hepatitis B elimination by 2030: the global burden of liver disease related to hepatitis B and association with socioeconomic status","volume":"16","author":"Cao","year":"","journal-title":"Hepatol. Int."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e0013822","DOI":"10.1128\/aac.00138-22","article-title":"Relationship between vancomycin trough serum concentrations and clinical outcomes in children: a systematic review and meta-analysis","volume":"66","author":"Cao","year":"","journal-title":"Antimicrob. Agents Chemother."},{"key":"B4","first-page":"3882","article-title":"Comparison of incidence of hepatocellular carcinoma between chronic hepatitis B patients with cirrhosis treated with entecavir or tenofovir in Taiwan - a retrospective study","volume":"10","author":"Chen","year":"2020","journal-title":"Am. J. Cancer Res."},{"key":"B5","doi-asserted-by":"publisher","first-page":"681","DOI":"10.3969\/j.issn.1672-5069.2018.05.007","article-title":"Preliminary study on the efficacy of tenofovir disoproxil in the treatment of multidrug-resistant hepatitis B cirrhosis patients","volume":"21","author":"Chen","year":"2018","journal-title":"J. Pract. Hepatology"},{"key":"B6","first-page":"109","article-title":"The impact of newer nucleos(t)ide analogues on patients with hepatitis B decompensated cirrhosis","volume":"28","author":"Cholongitas","year":"2015","journal-title":"Ann. Gastroenterology"},{"key":"B7","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1007\/s12664-015-0576-1","article-title":"Prolonged use of tenofovir and entecavir in hepatitis B virus-related cirrhosis","volume":"34","author":"Goyal","year":"2015","journal-title":"Indian J. Gastroenterol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"677920","DOI":"10.3389\/fmed.2021.677920","article-title":"External validation of aMAP hepatocellular carcinoma risk score in patients with chronic hepatitis B-related cirrhosis receiving ETV or TDF therapy","volume":"8","author":"Gui","year":"2021","journal-title":"Front. Med. (Lausanne)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1038\/s41575-023-00760-9","article-title":"Global burden of hepatitis B virus: current status, missed opportunities and a call for action","volume":"20","author":"Hsu","year":"2023","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1111\/apt.16116","article-title":"Five-year comparative risk of hepatocellular carcinoma development under entecavir or tenofovir treatment-na\u00efve patients with chronic hepatitis B-related compensated cirrhosis in Taiwan","volume":"52","author":"Hu","year":"2020","journal-title":"Aliment. Pharmacol. Ther."},{"key":"B11","doi-asserted-by":"publisher","first-page":"20406223221102791","DOI":"10.1177\/20406223221102791","article-title":"Tenofovir is superior to entecavir in reducing HCC for patients with HBV-related compensated cirrhosis at high HCC risk scores","volume":"13","author":"Huang","year":"2022","journal-title":"Ther. Adv. Chronic Dis."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1301120","DOI":"10.3389\/fphar.2023.1301120","article-title":"Comparative effectiveness of tenofovir versus entecavir in patients with hepatitis B virus-related cirrhosis in Taiwan: a retrospective cohort study","volume":"14","author":"Huang","year":"2023","journal-title":"Front. Pharmacol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.cgh.2012.10.003","article-title":"Long-term efficacy and safety of lamivudine, entecavir, and tenofovir for treatment of hepatitis B virus-related cirrhosis","volume":"11","author":"K\u00f6kl\u00fc","year":"2013","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1016\/j.jhep.2017.03.021","article-title":"EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection","volume":"67","author":"Lampertico","year":"2017","journal-title":"J. Hepatology"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1730","DOI":"10.1128\/aac.02483-13","article-title":"Prior exposure to lamivudine increases entecavir resistance risk in chronic hepatitis B Patients without detectable lamivudine resistance","volume":"58","author":"Lee","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"B16","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1007\/s12072-022-10357-0","article-title":"Comparable outcomes of decompensated chronic hepatitis B patients treated with entecavir or tenofovir: an 8-year cohort study","volume":"16","author":"Lee","year":"2022","journal-title":"Hepatol. Int."},{"key":"B17","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1002\/aid2.13362","article-title":"Entecavir versus tenofovir disoproxil fumarate on the reduction of incidence of hepatocellular carcinoma in patients with chronic hepatitis B-related liver cirrhosis","volume":"11","author":"Lin","year":"2024","journal-title":"Adv. Dig. Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1111\/apt.15499","article-title":"Tenofovir disoproxil fumarate reduces hepatocellular carcinoma, decompensation and death in chronic hepatitis B patients with cirrhosis","volume":"50","author":"Liu","year":"2019","journal-title":"Aliment. Pharmacol. Ther."},{"key":"B19","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1111\/jvh.12613","article-title":"No detectable resistance to tenofovir disoproxil fumarate in HBeAg+ and HBeAg- patients with chronic hepatitis B after 8 years of treatment","volume":"24","author":"Liu","year":"2017","journal-title":"J. Viral Hepat."},{"key":"B20","volume-title":"Effect of entecavir and tenofovir on the incidence rate of liver cancer in patients with chronic hepatitis B cirrhosis","author":"Luo","year":"2022"},{"key":"B21","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1136\/gutjnl-2016-312653","article-title":"Induction of IFN-\u03bb3 as an additional effect of nucleotide, not nucleoside, analogues: a new potential target for HBV infection","volume":"67","author":"Murata","year":"2018","journal-title":"Gut"},{"key":"B22","doi-asserted-by":"publisher","first-page":"828","DOI":"10.5009\/gnl16484","article-title":"Effects of entecavir and tenofovir on renal function in patients with hepatitis B virus-related compensated and decompensated cirrhosis","volume":"11","author":"Park","year":"2017","journal-title":"Gut Liver"},{"key":"B23","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1016\/S0140-6736(12)61425-1","article-title":"Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study","volume":"381","author":"Patrick","year":"2015","journal-title":"Lancet London, Engl."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12072-015-9675-4","article-title":"Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update","volume":"10","author":"Sarin","year":"2016","journal-title":"Hepatol. Int."},{"key":"B25","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur. J. Epidemiol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"Bmj"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1560","DOI":"10.1002\/hep.29800","article-title":"Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance","volume":"67","author":"Terrault","year":"2018","journal-title":"Hepatology"},{"key":"B28","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1016\/j.jfma.2016.08.006","article-title":"Long-term outcomes of hepatitis B virus-related cirrhosis treated with nucleos(t)ide analogs","volume":"116","author":"Tsai","year":"2017","journal-title":"J. Formos. Med. Assoc."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3969\/j.issn.1674-7380.2021.03.001","article-title":"Early efficacy of propafenone fumarate in the initial treatment of decompensated hepatitis B cirrhosis Chinese","volume":"13","author":"Wang","year":"2021","journal-title":"J. Hepatology Electron. Ed."},{"key":"B30","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.future.2018.12.022","article-title":"Receiver Operating Characteristics (ROC) Analysis for decreased disease risk and elevated treatment response to pegylated-interferon in chronic hepatitis B patients (Retraction of Vol 98, Pg 372, 2019)","author":"Wen","year":"2020","journal-title":"Future gener. Comput. Syst. FGCS"},{"key":"B31","doi-asserted-by":"publisher","first-page":"5088","DOI":"10.3748\/wjg.v27.i30.5088","article-title":"Clinical efficacy of antiviral therapy in patients with hepatitis B-related cirrhosis after transjugular intrahepatic portosystemic shunt","volume":"27","author":"Yao","year":"2021","journal-title":"World J. Gastroenterol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1111\/hepr.13678","article-title":"Evidence-based clinical practice guidelines for liver cirrhosis 2020","volume":"51","author":"Yoshiji","year":"2021","journal-title":"Hepatol. Res."},{"key":"B33","doi-asserted-by":"publisher","first-page":"457","DOI":"10.3969\/j.issn.1672-5069.2023.03.040","article-title":"Guidelines for the prevention and treatment of chronic hepatitis B (2022 edition)","volume":"26","author":"You","year":"2023","journal-title":"J. Pract. Hepatology"}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2025.1507117\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T07:21:45Z","timestamp":1737357705000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2025.1507117\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,20]]},"references-count":33,"alternative-id":["10.3389\/fphar.2025.1507117"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2025.1507117","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,20]]},"article-number":"1507117"}}