Effectiveness and Safety of Foscarnet Sodium in Treating Chronic HBV Hepatitis: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

HE Qing ¹ , XU Cheng ¹ , WANG Song ¹ ,  ZHAO Liansan ²

1.East Lake Hospital of Shen Zhen, Shenzhen 518020, China 2.Center of Infectious Disease, West China Hospital of Sichuan University, Chengdu 610041, China;

Corresponding author：

ZHAO Liansan, Email: heqingjoe@163.com

Keywords：

Foscarnet sodium; Chronic HBV hepatitis; Systematic review; Randomized controlled trials

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Objective 　To evaluate the effectiveness and safety of foscarnet sodium in the treatment of chronic hepatitis B.
Methods 　We searched MEDLINE, EMbase, The Cochrane Library and CNKI from 1978 to June 2006. Randomized controlled trials of foscarnet sodium versus other drugs or no drugs in the treatment of chronic hepatitis B were identified. The quality of the included trials was evaluated by two reviewers independently. Meta-analysis was done using The Cochrane Collaboration’s RevMan 4.2.7.
Results 　Seven studies (337 patients) were included; one compared foscarnet sodium versus interferon, and the other six compared foscarnet sodium versus no drugs. All the included studies were graded in terms of the quality of randomization, allocation concealment and blinding. All 7 studies were graded as level C. The meta-analysis showed that: ① foscarnet sodium was not significantly different from interferon in clinical efficacy, liver function, negative-conversion rate of virological markers and side effects. ② compared with the no drugs group, the negative-conversion rate of virological markers was significantly higher for the foscarnet sodium group, HBeAg (RR 6.20, 95%CI 1.76 to 21.79) and HBV-DNA (RR 4.13, 95%CI 1.32 to 12.86); but there were no significant differences in clinical efficacy, liver function and side effects.
Conclusions 　Available evidence shows that: in the treatment of chronic hepatitis B the effectiveness and safety of foscarnet sodium are not significantly different from interferon, but only one trial is included in this review, so the evidence is weak. Compared with no drugs, foscarnet sodium significantly improves the negative-conversion rate of virological markers, but the evidence is insufficient to show whether foscarnet sodium could improve clinical efficacy and liver function, as well as reduce side effects.

Citation： HE Qing,XU Cheng,WANG Song,ZHAO Liansan. Effectiveness and Safety of Foscarnet Sodium in Treating Chronic HBV Hepatitis: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2006, 06(10): 721-726. doi: Copy

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31.	–2444.

1. 张瑞祺, 缪晓辉, 等. 膦甲酸钠抗乙型肝炎病毒近期疗效观察. 解放军医学杂志, 2002; 27(3): 256–257.
2. 病毒性肝炎防治方案(试行). 1995年北京第5次全国传染病与寄生虫病学术会议讨论修订. 中华传染病杂志, 1995; 13(4):.
3. 中华医学会传染病与寄生虫病学分会肝病学分会联合修订. 病毒性肝炎的诊断标准. 中西医结合肝病杂志, 2001; 11(1): 56–60.
4. 昌荣林，陈红，孙美祥. 可耐治疗慢性乙肝的疗效观察. 临床医学, 2003; 23(8): 54.
5. 甘雪婷, 白宪光, 伍秀珍, 等. 膦甲酸钠(可耐)治疗慢性乙型肝炎及其对HBV2DNA 的影响. 临床军医杂志, 2004; 32(6): 5–7.
6. 张明, 石善江, 刘立民, 等. 膦甲酸钠治疗急性乙型临界性重型肝炎的临床疗效. 临床肝胆病杂志, 2001; 17(4): 229–230.
7. 陈明全, 许夕海, 施光峰. 膦甲酸钠治疗慢性重型乙型病毒性肝炎疗效观察. 现代诊断与治疗, 2003; 14(6): 347–348.
8. 任泽久, 陈悦, 龚钰清, 等. 膦甲酸钠治疗慢性乙型重型肝炎临床疗效观察. 实用肝脏病杂志, 2004; 7(3): 141–142.
9. 罗欣拉, 朱清静, 陆定波. 膦甲酸钠联合中药治疗慢性乙型肝炎中度25例. 中西医结合肝病杂志, 2002; 12(3): 172–173.
10. 尹桃，刘双虎. 膦甲酸钠与α-干扰素治疗慢性乙型肝炎的疗效比较及成本–效果分析. 药物经济学, 2002; 13(11): 663–664.
11. Ganem D, Prince AM. Hepatitis B virus infection—natural history and clinical consequences. N Engl J Med. 2004; 350: 1118–1129.
12. Zhang RQ, Miu XH, Cai X, et al. Short-term anti-HBV efficacy of foscarnet sodium. Medical Journal of Chinese People’s Liberation Army, 2002; 27(3): 256–257.
13. Pan CQ, Zhang JX. Natural History and Clinical Consequences of Hepatitis B Virus Infection. Int J Med Sci, 2005; 2: 36–40.
14. Wong DK, Cheung AM, O’Rourke K, et al. Effect of alpha-interferon treatment in patients with hepatitis Be antigen-positive chronic hepatitis B. A meta-analysis. Ann Intern Med, 1993; 119(4): 312–323.
15. Dienstag JL, Schiff ER, Wright TL, et al. Lamivudine as initial treatment for chronic hepatitis B in the United States. N Engl J Med, 1999; 341: 1256–1263.
16. Lai C L, Chien RN, Leung NW, et al. A one-year trial of lamivudine for chronic hepatitis B. Asia Hepatitis Lamivudine Study Group. N Engl J Med, 1998; 339: 61–68.
17. Schalm SW, Heathcote J, Cianciara J, et al. Lamivudine and alpha interferon combination treatment of patients with chronic hepatitis B infection: a randomised trial. Gut, 2000; 46: 562–568.
18. Perrillo R, Schiff E, Yoshida E, et al. Adefovir dipivoxil for the treatment of lamivudine-resistant hepatitis B mutants. Hepatology, 2000; 32: 129–134.
19. Cullen JM, Li DH, Brown C, et al. Antiviral efficacy and pharmacokinetics of oral adefovir dipivoxil in chronically woodchuck hepatitis virusinfected woodchucks. Antimicrobial Agents and Chemotherapy, 2001; 45: 2740–2745.
20. Nordenfelt E ,Oberg B ,Helgstrand E , et al. Inhibition of hepatitis B dane particle DNA polymerase activity by pyrophosphate analogs. Acta Pathol Microbiol Scand, 1980; 88(3): 169–175.
21. Janine SM, Tim S, Peter WA, et al. Effect of immunosuppressive and antiviral agents on hepatitis B virus replication in vitro. Hepatology, 1995; 22: 36–43.
22. Guideline: prevention and treatment of viral hepatitis (draft). The fifth national conference on contagious disease and parasitic disease. Chin J Infect Dis, 1995; 13(4): 2422–2444.
23. Chinese Society of Infectious Diseases and Parasitology and Chinese Society of Hepatology of Chinese Medical Association. The progamme of prevention and cure for viral hepatitis. Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases, 2001; 11(1): 56–60.
24. Chang RL, Chen H, Sun MX. Clinical efficacy of carnet in the treatment of chronic hepatitis B. Clinical Medicine, 2003; 23(8): 54.
25. Gan XT, Bai XG, Wu XZ, et al. Efficacy of foscarnet sodium (carnet) in the treatment of chronic hepatitis B and its effect on HBV2DNA. Clinical Journal of Medical Officer, 2004; 32(6): 5–7.
26. Zhang M, Shi SJ, Liu LM, et al. The clinical effect of the treatment with foscarnet in acute borderling severe hepatitis caused by HBV. Chinese Journal of Clinical Hepatology, 2001; 17(4): 229–230.
27. Chen MQ, Xu XH, Shi GF. Observation on effects of foscarnet sodium treating patients with severe chronic hepatitis B. Modern Diagnosis & Treatment, 2003; 14(6): 347–348.
28. Ren ZJ, Chen Y, Gong YQ, et al. Clinical effect of foscarnet in treating patients with chronic fulminant hepatitis B. Journal of Clinical Hepatology, 2004; 7(3): 141–142.
29. Luo XL, Zhu QJ, Lu DB. Combination of foscarnet sodium and traditional Chinese medicine treating moderate chronic hepatitis B in 25 cases. Journal of Integrated Traditional and Western Medicine on Liver Diseases, 2002; 12(3): 172–173.
30. Yin T, Liu SH. Comparison of therapeutic effects and cost-effectiveness analysis of foscarnet and α-interferon for chronic hepatitis B. Pharmacoeconomics, 2002; 13(11): 663–664.
31. –2444.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Foscarnet Sodium in Treating Chronic HBV Hepatitis: A Systematic Review

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