Potent antiviral therapy improves survival in acute on chronic liver failure due to hepatitis B virus reactivation

Table 5 Summary of older studies that dealt with role of entecavir and entacavir vs lamivudine in patients of hepatitis B virus-related acute on chronic liver failure[52-55]

Study	Patient No.	Drug used (no. of patients treated)	Clinical implications	Salient features	Conclusion
Chen et al[53]	55	Entecavir	ALT, albumin, bilirubin, PT; no significant change between groups	No difference in mortality rates below 3 mo and after 3 mo, MELD not affected between groups	Short-term suppression of HBV replication offers no benefit on survival
Wong et al[56]	124	Entecavir	Treatment achieved	Tongji prognostic predictor model is better than MELD in prognostication in HBV-ACLF	Entecavir prevents disease progression and increases the
			< 3 logs HBV DNA; significantly higher survival rate; prevention of liver or renal dysfunction		survival of patients with HBV-ACLF
Shouval et al[61]	36 vs 117	Entecavir (36); Lamivudine (117)	Prolonged jaundice, encephalopathy, ascites in Entecavir group	More liver-related mortality in entecavir group, faster virological response	Short-term mortality high in entecavir group, but faster reduction in viral load
Cui et al[58]	33/34/37	Entecavir (33); lamivudine (34); placebo (37)	Liver function and MELD scores did not improve significantly	No significant difference in 3-mo survival was observed, levels of HBV DNA and rates of recurrence of HBV-associated ACLF were lower	Nucleoside analog treatment did not improve the short-term prognosis of patients with HBV-associated ACLF although it was efficacious and safe in the management of HBV DNA levels
Imamura et al[20]	34	Entecavir and lamivudine consecutively	No reduction of < 1 log IU/mL in HBV DNA after 1 or 3 mo of treatment. Initial virological response, with lamivudine and entecavir, respectively, was 83.3% and 100%	Twelve months after treatment, 41.6% of 24 lamivudine group patients switched to another drug or added adefovir to their treatment due to the emergence of lamivudine-resistant mutants	Entecavir appears to be as effective as lamivudine in the treatment of patients with acute exacerbation of chronic hepatitis B

HBV: Hepatitis B virus; ACLF: Acute on chronic liver failure.