Comparative efficacy and safety of pharmacologic interventions to prevent mother-to-child transmission of hepatitis B virus: a systematic review and network meta-analysis - 20/07/22
, Toi L. Phung, PhD a, d, Thunyarat Anothaisintawee, PhD a, e, Usa Chaikledkaew, PhD a, c, Abhasnee Sobhonslidsuk, MD f, Pattarawalai Talungchit, PhD a, g, Nathorn Chaiyakunapruk, PhD h, John Attia, PhD i, Gareth J. McKay, PhD j, Ammarin Thakkinstian, PhD a, kAbstract |
Objective |
This study investigated the efficacy and safety of pharmacologic interventions to prevent vertical transmission of the hepatitis B virus.
Data Sources |
Medline, Cochrane, and Scopus databases were searched up to October 28, 2020.
Study Eligibility Criteria |
All randomized controlled trials reporting vertical hepatitis B virus transmission with pharmacologic intervention were included.
Methods |
Risk of bias was assessed using the Cochrane Risk-of-Bias tool, version 2. Treatment efficacy was estimated using stratified network meta-analysis on the basis of maternal hepatitis B envelope antigen status.
Results |
Nineteen studies were included for mothers positive for hepatitis B surface and envelope antigens. Pooling indicated that a combination of hepatitis B vaccination and hepatitis B immunoglobulin in infants significantly reduced transmission risk compared with vaccination alone, with a risk ratio of 0.52 (95% confidence interval; 0.30–0.91). Only the addition of maternal tenofovir disoproxil fumarate, but not telbivudine, lamivudine, or maternal hepatitis B immunoglobulin further reduced transmission risk compared with a combination of hepatitis B vaccination and hepatitis B immunoglobulin in infants, with a pooled risk ratio of 0.10 (0.03–0.35). Twelve studies conducted in mothers with hepatitis B surface antigen positivity and mixed, unknown, or negative hepatitis B envelope antigen status provided limited evidence to suggest that maternal hepatitis B immunoglobulin combined with hepatitis B vaccination and immunoglobulin in infants was the likely best treatment, but this failed to reach statistical significance compared with a combination of hepatitis B vaccination and immunoglobulin in infants. Similarly, infant hepatitis B immunoglobulin, added to vaccination, likely provides additional benefit but failed to reach statistical significance.
Conclusion |
A combination of hepatitis B vaccination and immunoglobulin in infants is the cornerstone for prevention of vertical transmission for mothers positive for both hepatitis B surface and envelope antigens. The addition of maternal tenofovir to this infant combination regimen was considered the likely most effective treatment. For infants of mothers with hepatitis B surface antigen positivity and mixed, unknown, or negative hepatitis B envelop antigen status, no additional agents provided further benefit beyond hepatitis B vaccination alone.
Le texte complet de cet article est disponible en PDF.Key words : hepatitis B immune globulin, hepatitis B virus, lamivudine, telbivudine, tenofovir, vertical transmission
Plan
| The authors report no conflict of interest. |
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| This study did not receive any funding. |
Vol 227 - N° 2
P. 163-172 - août 2022 Retour au numéro
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