Comparative efficacy and safety of pharmacological interventions to prevent Mother-to-Child transmission of hepatitis B virus: A systematic review and network meta-analysis

Ha T Nguyen, Montarat Thavorncharoensap, Toi L Phung, Thunyarat Anothaisintawee, Usa Chaikledkaew, Abhasnee Sobhonslidsuk, Pattarawalai Talungchit, Nathorn Chaiyakunapruk, John Attia, Gareth J McKAY, Ammarin Thakkinstian

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Abstract

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.

Original languageEnglish
JournalAmerican Journal of Obstetrics and Gynecology
Early online date06 Mar 2022
DOIs
Publication statusEarly online date - 06 Mar 2022

Bibliographical note

Funding Information:
This work was conducted as part of the Mahidol University Health Technology Assessment program through a scholarship provided by Mahidol University and the International Decision Support Initiative (iDSI). This work was produced as part of the iDSI ( www.idsihealth.org ) to support countries in obtaining optimal value for money from health spending. iDSI receives funding support from the Bill & Melinda Gates Foundation , the UK Department for International Development , and the Rockefeller Foundation . The findings, interpretations, and conclusions expressed in this article do not necessarily reflect the views of the aforementioned funding agencies.

Publisher Copyright:
© 2022 The Authors

Keywords

  • hepatitis B immune globulin
  • hepatitis B virus
  • lamivudine
  • telbivudine
  • tenofovir
  • vertical transmission

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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