替诺福韦地索普西富马酸盐转用替诺福韦阿拉芬胺治疗慢性

StephenW

J Viral Hepat. 2018 Dec 21. doi: 10.1111/jvh.13053. [Epub ahead of print]
Improvement of Bone Mineral Density and Markers of Proximal Renal Tubular Function in Chronic Hepatitis B Patients Switched from Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide.
Fong TL1,2, Lee BT2, Tien A1, Chang M1, Lim C1, Ahn A1, Bae HS1.
Author information

1
    Asian Pacific Liver Center at Saint Vincent Medical Center.
2
    Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Abstract

Tenofovir alafenamide (TAF) is a novel prodrug that reduces tenofovir plasma levels by 90% compared to tenofovir disoproxil fumarate (TDF), resulting in decreased bone mineral density (BMD) loss and renal toxicity. We aimed to study changes in BMD and markers of renal function of chronic hepatitis B (CHB) patients previously treated with TDF who were switched to TAF in as early as 12 weeks. This was a prospective single-arm open-label study of 75 CHB patients treated with TDF 300 mg daily who were switched to TAF 25 mg daily and followed for 24 weeks. All patients had been treated with TDF for at least 12 months and had HBV DNA < 21 IU/mL at the time of switch. BMD and markers of renal function were taken on the day of switch and repeated after 12 and 24 weeks of TAF treatment. Hip and spine bone mineral density significantly increased from baseline to week 12 (+ 12.9% and +2.4%, respectively, P<0.01). There were significant decreases in urinary beta-2-microglobulin to creatinine and retinol-binding protein to creatinine ratios by week 12 (P<0.01 for both). Mean estimated glomerular filtration rate did not change. Tubular reabsorption of phosphate was decreased at week 24 (P<0.05). In conclusion, CHB patients previously treated with TDF experienced significant improvement in bone density and some markers of renal tubular function and as early as 12 weeks after switching to TAF. Bone density changes associated with TDF may not be entirely related to renal handling of phosphate. This article is protected by copyright. All rights reserved.
KEYWORDS:

bone mineral density; hepatitis B; renal function; tenofovir alafenamide; tenofovir disoproxil fumarate

PMID:
    30576085
DOI:
    10.1111/jvh.13053

StephenW

J病毒肝病。 2018年12月21日doi：10.1111 / jvh.13053。 [提前打印]
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Fong TL1,2，Lee BT2，Tien A1，Chang M1，Lim C1，Ahn A1，Bae HS1。
作者信息

1
    圣文森特医疗中心的亚太肝脏中心。
2
    南加州大学凯克医学院胃肠和肝脏疾病科，美国加利福尼亚州洛杉矶。

抽象

替诺福韦艾拉酚胺（TAF）是一种新型前药，与替诺福韦地索普西富马酸盐（TDF）相比，可将替诺福韦血浆水平降低90％，从而导致骨矿物质密度（BMD）降低和肾毒性降低。我们的目的是研究先前接受TDF治疗的慢性乙型肝炎（CHB）患者的BMD和肾功能标志物的变化，这些患者最早在12周内转为TAF。这是一项前瞻性单臂开放标签研究，对75名CHB患者进行治疗，每日300 mg TDF治疗，每日服用25 mg TAF，随访24周。所有患者均接受TDF治疗至少12个月，转换时HBV DNA <21 IU / mL。在切换当天采集BMD和肾功能标志物，并在TAF治疗12和24周后重复。髋和脊柱骨矿物质密度从基线到第12周显着增加（分别为+ 12.9％和+ 2.4％，P <0.01）。到第12周，尿β-2-微球蛋白对肌酸酐和视黄醇结合蛋白与肌酸酐比率显着降低（两者均P <0.01）。平均估计的肾小球滤过率没有变化。第24周时，管状磷酸盐重吸收减少（P <0.05）。总之，之前接受过TDF治疗的CHB患者骨密度和肾小管功能的一些标志物在切换到TAF后早期经历了显着改善。与TDF相关的骨密度变化可能与磷的肾处理不完全相关。本文受版权保护。版权所有。
关键词：

骨密度;乙型肝炎;肾功能;替诺福韦艾拉酚胺;替诺福韦地索普西富马酸盐

结论：
    30576085
DOI：
    10.1111 / jvh.13053