- Title
- Comparative efficacy and safety of pharmacologic interventions to prevent mother-to-child transmission of hepatitis B virus: a systematic review and network meta-analysis
- Creator
- Nguyen, Ha T.; Thavorncharoensap, Montarat; Thakkinstian, Ammarin; Phung, Toi L.; Anothaisintawee, Thunyarat; Chaikledkaew, Usa; Sobhonslidsuk, Abhasnee; Talungchit, Pattarawalai; Chaiyakunapruk, Nathorn; Attia, John; McKay, Gareth J.
- Relation
- American Journal of Obstretics and Gynecology Vol. 227, Issue 2, p. 163-172
- Publisher Link
- http://dx.doi.org/10.1016/j.ajog.2022.02.042
- Publisher
- Mosby
- Resource Type
- journal article
- Date
- 2022
- Description
- 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.
- Subject
- hepatitis B immune globulin; hepatitis B virus; lamivudine; telbivudine; tenofovir; vertical transmission; SDG 3; SDG 5; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1486391
- Identifier
- uon:51837
- Identifier
- ISSN:0002-9378
- Language
- eng
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