Systematic review with meta-analysis: Change in liver stiffness during anti-viral therapy in patients with hepatitis B

Background: Time-varying impact of anti-viral therapy on liver stiffness in patients with hepatitis B is unclear. Aims: To estimate the magnitude and kinetics of change in liver stiffness in hepatitis B patients treated with nucleot(s)ide analogs. Methods: Through a systematic review of multiple databases, we identified 24 studies in adults with hepatitis B who underwent transient elastography before and at least 6 months after starting nucleot(s) ide analogs therapy. We estimated change in liver stiffness 6 m, 12 m, 24 m, 36 m and 60 m after starting therapy, as weighted mean difference and 95% confidence intervals, using random-effects meta-analysis. Results: Liver stiffness significantly declined by 2.21 kPa (95% CI, -1.36 to -3.05), 2.56 kPa (-2.23 to -2.89), 3.73 kPa (-2.98 to -4.49), 4.15 kPa (-2.75 to -5.54), and 5.19 kPa (-3.34 to -7.03) at 6 months, 1 year, 2 years, 3 years, and 5 years from the start of therapy, respectively (p < 0.001). High baseline alanine aminotransferase level, viral load and liver stiffness were associated with greater magnitude of decline in liver stiffness. Conclusions: Antiviral therapy is associated with progressive decline in liver stiffness in patients with hepatitis B, particularly in patients with high baseline alanine aminotransferase and viral load. (c) 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.