Single-drug treatments for chronic hepatitis B: summarising current information by network meta-analysis
Notice bibliographique
Résumé
Sirs, As pointed out by Rijckborst et al.,1 the most difficult decision in the first-line treatment for chronic hepatitis B (HB) is between pegylated interferon and nucleoside/nucleotide analogues given as monotherapy. While this decision should be made by carefully evaluating each patient, cases in whom the treatment with nucleotide analogues is preferred pose the question of choosing the best nucleotide analogue among those presently available (i.e. lamivudine, adefovir, telbivudine, entecavir and tenofovir). A recent article2 has systematically reviewed all clinical trials conducted in this area. However, if one accepts that nucleotide analogues are reserved for patients in whom the option of IFN has been excluded,1 a more selective analysis can be worthwhile in which the comparisons are restricted to nucleotide analogues given as monotherapy. To address this point, we have carried out a network meta-analysis (NetMA3) that was aimed at generating a summary NetMa graph wherein HBe antigen (Ag)-positive patients were analysed separately from HBeAg-negative patients. In both analyses, the end-point was the rate of virological response at 1 year (defined as attainment of undetectable levels of HBV DNA). Figure 1 shows the results of this NetMA. In HBeAg-positive patients (panel A), these data confirm that current effectiveness data favour entecavir and, to a lesser extent, tedofovir and adevofir; in HBeAg-negative patients (panel B), entecavir tends to be favoured as well, but the clinical trials are still too few. Nucleos(t)ide analogues given as monotherapy in the first-line treatment for hepatitis B: network meta-analysis. The graph summarises the results of both direct and indirect comparisons for HBeAg-positive patients (panel a) and HBeAg negative patients (panel b). Each direct comparison is represented by a solid line and each indirect comparison by a dotted line. The endpoint is the proportion of patients achieving virological response at 1 year. Statistical results of event rate ratio are presented as relative risk (RR) with 95% confidence interval (CI). The values of RR (with 95% CI) for direct and indirect comparisons were calculated according to the REVMAN and the ITC software, respectively. Information on the software and details about the trial-specific event rates are presented in the Supporting Information posted on the web. Symbols: ‘+’indicates which treatment is favoured at levels of statistical significance, and vice versa for ‘−’; ‘=’ denotes comparisons showing no significant difference; ‘t’ indicates which treatment is favoured by a trend in cases of no significant difference. The overall picture of the comparisons shown in Figure 1 can be a practical aid in the complex process of drug selection for an individual patient in which many factors are involved (e.g. effectiveness from clinical trials, recommendations from panels of experts, cost, cost/effectiveness as well as factors related to the individual patient concerned). The present analysis is based on the same graphical tool that we have previously applied to treatments for hepatitis C.4 Declaration of personal interests: None. Declaration of funding interests: One of the authors (DM) was supported by a grant from the Italian Society of Hospital Pharmacists. Table S1. Trial-specific rates of virological response at 1 year in HBeAg positive patients (from Woo et al. 2010): these data were used to generate the graph shown in Figure 1 (panel a). Table S2. Trial-specific rates of virological response at 1 year in HBeAg negative patients (from Woo et al. 2010): these data were used to generate the graph shown in Figure 1 (panel b). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,037 | 0,073 |
| Méta-épidémiologie (sens strict) | 0,004 | 0,002 |
| Méta-épidémiologie (sens large) | 0,017 | 0,039 |
| Bibliométrie | 0,012 | 0,012 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,003 | 0,003 |
| Intégrité de la recherche | 0,003 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».