Renal Function in Nucleos(t)ide Analog-Treated Patients With Chronic Hepatitis B: A Systematic Literature Review and Network Meta-Analysis

INTRODUCTION: Renal safety is an important factor in selecting the most appropriate nucleos(t)ide analog (NA) treatment for patients with chronic hepatitis B (CHB). This systematic literature review and network meta-analysis aimed to assess renal function associated with telbivudine treatment compared to other NAs in patients with CHB. METHODS: A systematic literature search via Medline, Medline In-Process, Embase, and the Cochrane library for publications of randomized controlled trials and observational studies was conducted. Network meta-analysis was performed to compare renal function with telbivudine treatment versus other NAs after 1 year of therapy. RESULTS: Overall, 40 (six randomized controlled and 34 observational) studies were included for review. Telbivudine consistently showed an improvement in renal function as measured by an estimated glomerular filtration rate (eGFR) over various time points regardless of the method of measurement. Changes in eGFR (mL/min) from baseline and corresponding 95% credible intervals with various NAs were as follows: monotherapies (telbivudine: 7.78 [6.91, 8.65], entecavir: −1.07 [−4.80, 2.62], lamivudine: −6.08 [−13.35, 1.15], tenofovir: −9.53 [−14.31, −4.89]) and combination therapies (telbivudine + adefovir: 8.37 [−34.00, 50.34], telbivudine + tenofovir: 8.29 [−0.05, 16.64], entecavir + adefovir: 4.15 [−38.55, 46.37], telbivudine + lamivudine: 0.51 [−11.77, 12.96], and lamivudine + adefovir: −0.39 [−42.48, 41.21]). At 1 year, the change in eGFR from baseline was significantly higher with telbivudine compared to other NAs. CONCLUSION: The systematic literature review and network meta-analysis provide evidence that telbivudine is associated with significant improvement in renal function in patients with CHB, either alone or in combination with other NAs. FUNDING: Novartis Pharma AG. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12325-016-0337-2) contains supplementary material, which is available to authorized users.