Original Article

A National Multicenter Study on Initial Antiviral Treatment Preferences on Chronic Hepatitis B: Entecavir Versus Tenofovir Disoproxil Fumarate

Volume 37 · Issue 2 Publish Date: October 23, 2025
Tansu Yamazhan ORCID Esra Zerdali ORCID Yusuf Önlen ORCID Selma Tosun ORCID Özgür Günal ORCID Ayşe Batırel ORCID İmran Hasanoğlu ORCID Tuba Turunç ORCID Umay Balcı ORCID Sibel Yıldız Kaya ORCID Oğuz Karabay ORCID İlknur Esen Yıldız ORCID Lütfiye Nilsun Altunal ORCID Hacer Deniz Özkaya ORCID Selçuk Kaya ORCID Ayşe İnci ORCID Sevil Alkan ORCID Dilek Sevgi Yıldız ORCID Tayibe Bal ORCID Esma Aslıhan Aydemir ORCID Nurullah Eser ORCID Serhat Uysal ORCID Oğuzhan Acet ORCID Fehmi Tabak ORCID Rahmet Güner ORCID
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Turkish Journal of Gastroenterology

Volume 37 · Issue 2

Pages: 179-185

History

Published Online: October 23, 2025

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This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright © 2025 Tansu Yamazhan, Esra Zerdali, Yusuf Önlen, Selma Tosun, Özgür Günal, Ayşe Batırel, İmran Hasanoğlu, Tuba Turunç, Umay Balcı, Sibel Yıldız Kaya, Oğuz Karabay, İlknur Esen Yıldız, Lütfiye Nilsun Altunal, Hacer Deniz Özkaya, Selçuk Kaya, Ayşe İnci, Sevil Alkan, Dilek Sevgi Yıldız, Tayibe Bal, Esma Aslıhan Aydemir, Nurullah Eser, Serhat Uysal, Oğuzhan Acet, Fehmi Tabak, Rahmet Güner

Tansu Yamazhan ORCID
Department of Infectious Diseases and Clinical Microbiology, Ege University Faculty of Medicine, Izmir, Türkiye
Esra Zerdali ORCID
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Turkey, Haseki Training and Research Hospital, İstanbul, Türkiye
Yusuf Önlen ORCID
Department of Infectious Diseases and Clinical Microbiology, Hatay Mustafa Kemal University Faculty of Medicine, Hatay, Türkiye
Selma Tosun ORCID
Department of Infectious Diseases and Clinical Microbiology, İzmir City Hospital, İzmir, Türkiye
Özgür Günal ORCID
Department of Infectious Diseases and Clinical Microbiology, Samsun University Faculty of Medicine, Samsun, Türkiye
Ayşe Batırel ORCID
Department of Infectious Diseases and Clinical Microbiology, İstanbul Lutfi Kırdar Kartal Training and Research Hospital, İstanbul, Türkiye
İmran Hasanoğlu ORCID
Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt Faculty of Medicine, Ankara, Türkiye
Tuba Turunç ORCID
Department of Infectious Diseases and Clinical Microbiology, Adana Health Sciences University Faculty of Medicine, Adana, Türkiye
Umay Balcı ORCID
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Turkey, Antalya Training and Research Hospital, Antalya, Türkiye
Sibel Yıldız Kaya ORCID
Department of Infectious Diseases and Clinical Microbiology, İstanbul University Cerrahpaşa Medical Faculty, İstanbul, Türkiye
Oğuz Karabay ORCID
Department of Infectious Diseases and Clinical Microbiology, Sakarya University Medical Faculty, Sakarya, Türkiye
İlknur Esen Yıldız ORCID
Department of Infectious Diseases and Clinical Microbiology, Recep Tayyip Erdoğan University Faculty of Medicine, Rize, Türkiye
Lütfiye Nilsun Altunal ORCID
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Türkiye
Hacer Deniz Özkaya ORCID
Department of Infectious Diseases and Clinical Microbiology, Bakırçay University, Çiğli Training and Research Hospital, İzmir, Türkiye
Selçuk Kaya ORCID
Department of Infectious Diseases and Clinical Microbiology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Türkiye
Ayşe İnci ORCID
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, İstanbul Training and Research Hospital, İstanbul, Türkiye
Sevil Alkan ORCID
Department of Infectious Diseases and Clinical Microbiology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Türkiye
Dilek Sevgi Yıldız ORCID
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
Tayibe Bal ORCID
Department of Infectious Diseases and Clinical Microbiology, Bolu Abant Izzet Baysal Faculty of Medicine, Bolu, Türkiye
Esma Aslıhan Aydemir ORCID
Department of Infectious Diseases and Clinical Microbiology, Samsun University Faculty of Medicine, Samsun, Türkiye
Nurullah Eser ORCID
Department of Infectious Diseases and Clinical Microbiology, İstanbul Lutfi Kırdar Kartal Training and Research Hospital, İstanbul, Türkiye
Serhat Uysal ORCID
Department of Infectious Diseases and Clinical Microbiology, Fırat University Faculty of Medicine Elazığ, Türkiye
Oğuzhan Acet ORCID
Department of Infectious Diseases and Clinical Microbiology, Ege University Faculty of Medicine, Izmir, Türkiye
Fehmi Tabak ORCID
Department of Infectious Diseases and Clinical Microbiology, İstanbul University Cerrahpaşa Medical Faculty, İstanbul, Türkiye
Rahmet Güner ORCID
Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt Faculty of Medicine, Ankara, Türkiye
Yamazhan, T., Zerdali, E., Önlen, Y., Tosun, S., Günal, Özgür, Batırel, A., … Güner, R. (2025). A National Multicenter Study on Initial Antiviral Treatment Preferences on Chronic Hepatitis B: Entecavir Versus Tenofovir Disoproxil Fumarate. Turkish Journal of Gastroenterology, 37(2), 179–185. https://doi.org/10.5152/tjg.2025.24741
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Abstract

Background/Aims: Selecting the initial antiviral regimen for chronic hepatitis B (CHB) requires balancing patients’ comorbidities and long-term safety. This study examines the differences in patient and disease-related factors that guide clinicians to prescribe either entecavir (ETV) or tenofovir disoproxil fumarate (TDF) as the initial treatment.

Materials and Methods: The study included treatment-naïve CHB patients aged 18 or older who had been diagnosed for at least 1 year since 2010 and initiated on antiviral therapy. The data included variables such as age, gender, body mass index (BMI), comorbidities, liver disease activity, biopsy results, cirrhosis, hepatic steatosis, hepatitis B e antigen status, hepatitis B virus DNA levels, triglycerides, cholesterol, renal function, and baseline bone mineral density (BMD), which were assessed by dual-energy x-ray absorptiometry (DEXA).

Results: Among 2259 patients (61.6% male), 1270 patients (56.22%) received TDF, while 989 patients (43.78%) received ETV as first line therapy. The TDF was more commonly prescribed to patients with a lower BMI (median 25.7 vs. 26.2, P = .001) and lower baseline creatinine (0.75 vs. 0.80 for ETV, P < .001). Clinicians preferred ETV among patients with an estimated glomerular filtration rate (eGFR) < 60 (n = 36), (P < .001). The BMD was evaluated in 365 patients (16.3%). The DEXA scans were performed for 116 patients (11.8%) in the ETV group and 249 patients (19.8%) in the TDF group (P < .001).

Conclusions: This national multicenter study emphasizes that patient-related factors, including gender, age, baseline renal function, and liver disease severity, significantly influence the choice of first-line antiviral therapy for CHB, often outweighing disease-specific factors.

 

Cite this article as: Yamazhan T, Zerdali E, Önlen Y, et al. A national multicenter study on initial antiviral treatment preferences on chronic hepatitis B: Entecavir versus tenofovir disoproxil fumarate. Turk J Gastroenterol. 2026;37(2):179-185.

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Article Info
Published In
Journal Turkish Journal of Gastroenterology
Volume / Issue Volume 37 · Issue 2
Pages 179-185
DOI 10.5152/tjg.2025.24741
History
Published Online October 23, 2025
License
Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright
Copyright (c) 2025 Tansu Yamazhan, Esra Zerdali, Yusuf Önlen, Selma Tosun, Özgür Günal, Ayşe Batırel, İmran Hasanoğlu, Tuba Turunç, Umay Balcı, Sibel Yıldız Kaya, Oğuz Karabay, İlknur Esen Yıldız, Lütfiye Nilsun Altunal, Hacer Deniz Özkaya, Selçuk Kaya, Ayşe İnci, Sevil Alkan, Dilek Sevgi Yıldız, Tayibe Bal, Esma Aslıhan Aydemir, Nurullah Eser, Serhat Uysal, Oğuzhan Acet, Fehmi Tabak, Rahmet Güner
Affiliations
Tansu Yamazhan ORCID
Department of Infectious Diseases and Clinical Microbiology, Ege University Faculty of Medicine, Izmir, Türkiye
Esra Zerdali ORCID
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Turkey, Haseki Training and Research Hospital, İstanbul, Türkiye
Yusuf Önlen ORCID
Department of Infectious Diseases and Clinical Microbiology, Hatay Mustafa Kemal University Faculty of Medicine, Hatay, Türkiye
Selma Tosun ORCID
Department of Infectious Diseases and Clinical Microbiology, İzmir City Hospital, İzmir, Türkiye
Özgür Günal ORCID
Department of Infectious Diseases and Clinical Microbiology, Samsun University Faculty of Medicine, Samsun, Türkiye
Ayşe Batırel ORCID
Department of Infectious Diseases and Clinical Microbiology, İstanbul Lutfi Kırdar Kartal Training and Research Hospital, İstanbul, Türkiye
İmran Hasanoğlu ORCID
Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt Faculty of Medicine, Ankara, Türkiye
Tuba Turunç ORCID
Department of Infectious Diseases and Clinical Microbiology, Adana Health Sciences University Faculty of Medicine, Adana, Türkiye
Umay Balcı ORCID
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Turkey, Antalya Training and Research Hospital, Antalya, Türkiye
Sibel Yıldız Kaya ORCID
Department of Infectious Diseases and Clinical Microbiology, İstanbul University Cerrahpaşa Medical Faculty, İstanbul, Türkiye
Oğuz Karabay ORCID
Department of Infectious Diseases and Clinical Microbiology, Sakarya University Medical Faculty, Sakarya, Türkiye
İlknur Esen Yıldız ORCID
Department of Infectious Diseases and Clinical Microbiology, Recep Tayyip Erdoğan University Faculty of Medicine, Rize, Türkiye
Lütfiye Nilsun Altunal ORCID
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Türkiye
Hacer Deniz Özkaya ORCID
Department of Infectious Diseases and Clinical Microbiology, Bakırçay University, Çiğli Training and Research Hospital, İzmir, Türkiye
Selçuk Kaya ORCID
Department of Infectious Diseases and Clinical Microbiology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Türkiye
Ayşe İnci ORCID
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, İstanbul Training and Research Hospital, İstanbul, Türkiye
Sevil Alkan ORCID
Department of Infectious Diseases and Clinical Microbiology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Türkiye
Dilek Sevgi Yıldız ORCID
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
Tayibe Bal ORCID
Department of Infectious Diseases and Clinical Microbiology, Bolu Abant Izzet Baysal Faculty of Medicine, Bolu, Türkiye
Esma Aslıhan Aydemir ORCID
Department of Infectious Diseases and Clinical Microbiology, Samsun University Faculty of Medicine, Samsun, Türkiye
Nurullah Eser ORCID
Department of Infectious Diseases and Clinical Microbiology, İstanbul Lutfi Kırdar Kartal Training and Research Hospital, İstanbul, Türkiye
Serhat Uysal ORCID
Department of Infectious Diseases and Clinical Microbiology, Fırat University Faculty of Medicine Elazığ, Türkiye
Oğuzhan Acet ORCID
Department of Infectious Diseases and Clinical Microbiology, Ege University Faculty of Medicine, Izmir, Türkiye
Fehmi Tabak ORCID
Department of Infectious Diseases and Clinical Microbiology, İstanbul University Cerrahpaşa Medical Faculty, İstanbul, Türkiye
Rahmet Güner ORCID
Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt Faculty of Medicine, Ankara, Türkiye
Cite this Article
Yamazhan, T., Zerdali, E., Önlen, Y., Tosun, S., Günal, Özgür, Batırel, A., … Güner, R. (2025). A National Multicenter Study on Initial Antiviral Treatment Preferences on Chronic Hepatitis B: Entecavir Versus Tenofovir Disoproxil Fumarate. Turkish Journal of Gastroenterology, 37(2), 179–185. https://doi.org/10.5152/tjg.2025.24741
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