Besifovir dipivoxil maleate versus other antivirals in reducing hepatocellular carcinoma in chronic hepatitis B

Besifovir dipivoxil maleate (BSV) has potent antiviral efficacy against chronic hepatitis B (CHB). This study investigated the efficacy of BSV in reducing hepatocellular carcinoma (HCC) development compared to other antiviral therapy (AVT) agents. We conducted a retrospective cohort study on treatment-naïve patients with CHB who initiated an AVT between 2017 and 2022 with BSV (n = 486), entecavir (ETV) (n = 852), tenofovir alafenamide (TAF) (n = 801), or tenofovir disoproxyl fumarate (TDF) (n = 750). The incidence and hazard ratio (HR) of HCC were calculated. The incidence of HCC in BSV users (n = 6, 4.3 per 1000 person-years [PYs]) was similar to that in TAF users (n = 21, 9.2 per 1000 PYs, log-rank P = 0.086, HR = 2.191, 95% confidence interval [CI] 0.884-5.434), but significantly lower than that in ETV users (n = 38, 12.5 per 1000PYs, log-rank P = 0.026, HR = 2.627, 95% CI 1.103-6.255) and TDF users (n = 32, 12.3 per 1000PYs, log-rank P = 0.028, HR = 2.623, 95% CI 1.090-6.311). Similarly, compared to BSV users, the adjusted HRs for ETV, TAF, and TDF users were higher after stabilized inverse probability of treatment weighting (2.836, 2.784, and 3.294, respectively) and pairwise propensity score matching (3.200, 3.250, and 3.750, respectively) (all P < 0.05). BSV demonstrated comparable efficacy in HCC reduction compared to other AVTs.