Comparative Effectiveness and Safety of Entecavir vs. Tenofovir in Hepatitis B: A Systematic Review
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Abstract
Chronic hepatitis B (CHB) remains a critical global health issue, often progressing to hepatocellular carcinoma (HCC) and liver-related mortality. Entecavir (ETV) and tenofovir (TDF/TAF) are established first-line antiviral therapies; however, their comparative efficacy and long-term safety profiles require further evaluation to inform clinical decision-making. This systematic review aims to compare the effectiveness and extrahepatic safety of entecavir and tenofovir in managing CHB, with a focus on long-term clinical outcomes and treatment-related complications. A systematic review was conducted based on PRISMA guidelines, identifying studies published between 2020 and 2025 from PubMed and ScienceDirect. The selection included 13 peer-reviewed clinical studies that met strict inclusion criteria related to efficacy outcomes, renal and bone safety, and patient-specific prognostic indicators. Both entecavir and tenofovir demonstrated significant virological suppression and reduction in HCC risk. Tenofovir was associated with improved overall survival, particularly in patients with decompensated liver disease. However, renal impairment was more frequently reported among tenofovir users, suggesting a need for careful monitoring or consideration of alternative agents such as TAF. While both agents are effective, treatment selection should be individualized based on renal function, HCC risk, and previous therapy history. Clinicians are encouraged to balance efficacy with safety considerations to optimize patient outcomes in CHB management.
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