评论文章：口服抗病毒治疗慢性乙型肝炎的长期安全性

StephenW

Aliment Pharmacol Ther. 2018 Jan 22. doi: 10.1111/apt.14497. [Epub ahead of print]
Review article: long-term safety of oral anti-viral treatment for chronic hepatitis B.Wong GL1,2,3, Seto WK4,5, Wong VW1,2,3, Yuen MF4,5, Chan HL1,2,3.
Author information
1Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong, China.2Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong, China.3State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong, China.4Department of Medicine & State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong.5Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.

AbstractBACKGROUND: Safety profile of nucleos(t)ide analogues is an important issue in view of its widespread use for decades in patients with chronic hepatitis B (CHB).
AIM: To review and evaluate the latest evidence on the safety profiles of the six approved nucleoside analogues.
METHODS: Relevant articles related to nucleoside analogue safety were selected for review following extensive language- and date-unrestricted, electronic searches of the literature.
RESULTS: Nephrotoxicity has been well reported in patients received older generations of nucleotide analogues, namely adefovir dipivoxil and tenofovir disoproxil fumarate (TDF). Yet risks of renal failure and renal replacement therapy were similar in patients treated with nucleoside analogues versus nucleotide analogues in real-life setting. Bone toxicity is closely related to nucleoside analogue effect on renal proximal tubular and phosphaturia. Real-life data demonstrated increased risk of hip fracture in patients received adefovir but not TDF. The newly approved tenofovir alafenamide (TAF) has improved renal and bone safety profiles compared to TDF. Long-term use of nucleoside analogues eg entecavir does not increase the risk of other cancers. Muscular toxicity may be seen in telbivudine-treated patients so regular monitoring is advised. Peripheral neuropathy and lactic acidosis are rare adverse events. Latest international guidelines support the use of TDF, telbivudine and lamivudine during pregnancy; breastfeeding is not contraindicated during TDF therapy.
CONCLUSIONS: Long-term safety profile of nucleoside analogues is now better defined with more data from large real-life cohorts and clinical trials with long-term follow-up. The new nucleotide analogue, TAF is now available with favourable renal and bone safety profiles.

© 2018 John Wiley & Sons Ltd.

PMID:29359487DOI:10.1111/apt.14497

StephenW

Aliment Pharmacol Ther。 2018 Jan 22 doi：10.1111 / apt.14497。 [电子版提前打印]
评论文章：口服抗病毒治疗慢性乙型肝炎的长期安全性
黄GL1,2,3，濑户WK4,5，黄VW1,2,3，元MF4,5，陈HL1,2,3。
作者信息

1
    香港中文大学香港特别行政区消化疾病研究所
2
    香港中文大学医学与治疗学系，香港特别行政区，中国香港。
3
    香港中文大学消化疾病国家重点实验室香港特别行政区香港特别行政区中国香港特别行政区
4
    香港大学医学部和肝脏研究国家重点实验室。
五
    深圳市深港医院医学科。

抽象
背景：

考虑到其在慢性乙型肝炎（CHB）患者中广泛使用数十年，核苷（酸）类似物的安全性是重要的问题。
目标：

审查和评估六个核准的核苷类似物安全性概况的最新证据。
方法：

有关核苷类似物安全性的相关文章被选中以供广泛的语言和日期不受限制的电子检索文献进行审查。
结果：

在接受老一代核苷酸类似物，即阿德福韦酯和富马酸替诺福韦酯（TDF）的患者中肾毒性已得到很好的报道。肾功能衰竭和肾替代疗法的风险在用核苷类似物治疗的患者与在现实生活中的核苷酸类似物相似。骨毒性与近端肾小管和磷酸尿的核苷类似物作用密切相关。实际数据显示，接受阿德福韦治疗但不是TDF的患者髋部骨折风险增加。与TDF相比，新批准的替诺福韦艾拉酚胺（TAF）具有改善的肾脏和骨骼安全性。长期使用核苷类似物如恩替卡韦不会增加其他癌症的风险。在替比夫定治疗的患者中可能会出现肌肉毒性，因此建议定期监测。周围神经病变和乳酸酸中毒是罕见的不良事件。最新的国际准则支持在怀孕期间使用TDF，替比夫定和拉米夫定;在TDF治疗期间，母乳喂养不是禁忌的。
结论：

核苷类似物的长期安全性现在可以通过大量现实生活中的队列和长期随访的临床试验得到更多的数据来更好地确定。新的核苷酸类似物TAF现在具有有利的肾和骨安全性概况。

©2018 John Wiley＆Sons Ltd.

结论：
    29359487
DOI：
    10.1111 / apt.14497