运用EASL 2017标准将乙型肝炎患者从替诺福韦酯2换用恩替卡韦

StephenW

Application of EASL 2017 criteria for switching hepatitis B patients from tenofovir disoproxil to entecavir or tenofovir alafenamide
Luisa Roade  1 , Alessandro Loglio  2 , Marta Borghi  2 , Mar Riveiro-Barciela  1 , Roberta Soffredini  2 , Floriana Facchetti  2 , Dhanai di Paolo  2 , David Tabernero  3 , Giovanna Lunghi  4 , Rafael Esteban  1 , Maria Buti  5 , Pietro Lampertico  6
Affiliations

    PMID: 32703729 DOI: 10.1016/j.dld.2020.06.037

Abstract

Background: To overcome safety limitations of tenofovir-disoproxil, EASL guidelines proposed switching chronic hepatitis B patients older than 60 years or with bone or renal disease to tenofovir-alafenamide or entecavir.

Aims: To estimate the number of patients who would benefit from a treatment switch in a real-life setting.

Methods: Consecutive hepatitis B patients receiving tenofovir-disoproxil before 31 December 2017 were enrolled in a cross-sectional study in two European hospitals. Clinical and virological data were recorded; renal function was assessed by estimated glomerular filtrate rate, serum phosphate and creatinine, proteinuria, and albuminuria; bone involvement by spine and femur DEXA scan.

Results: In total, 565 patients included: 62 (18-91) years, 75% males, 92% Caucasian, 92% HBeAg-negative, 40% cirrhotic. Fifty-five percent of patients fulfilled age criterion (>60 years). Older patients had higher rates of cirrhosis (51% vs 26%, p<0.001), cardiovascular disease, and renal impairment. Thirty-six percent of patients met renal criteria, more commonly NA-experienced individuals (35% vs 21%, p=0.001); 17% had bone disease. Overall, 66% of patients had at least one criterion (71% if NA-experienced), 8% all three criteria, 28% age and renal criteria.

Conclusions: Approximately two-thirds of patients receiving long-term tenofovir-disoproxil are candidates for an entecavir or tenofovir-alafenamide switch according to EASL recommendations.

Keywords: Bone safety; ETV; HBV; Nucleos(t)ide analogues; Renal safety; TAF; TDF.

Copyright © 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Conflict of interest statement

Declaration of Competing Interest M. Buti and R. Esteban report grant support and/or consultancy and lecture fees from AbbVie, Gilead Sciences, Bristol-Myers Squibb, Janssen and MSD. M. Riveiro-Barciela reports lecture fees from Gilead Sciences. P.Lampertico is an Advisory Board/Speaker Bureau for BMS, Roche, Gilead Sciences, GSK, Abbvie, MSD, Arrowhead, Alnylam, Janssen, Spring Bank, Myr-pharma, Eiger. A. Loglio is a Speaker Bureau for Gilead Sciences, Myr-pharma.

StephenW

运用EASL 2017标准将乙型肝炎患者从替诺福韦酯2换用恩替卡韦或替诺福韦alafenamide
露易莎（Luisa Roade）1，亚历山德罗·洛格里奥（Alessandro Loglio）2，玛尔塔·伯格（Marta Borghi）2，玛尔·里维罗-巴西埃拉（Marta Riveiro-Barciela）1，罗伯塔·索弗雷迪尼（Roberta Soffredini）2，弗洛里亚纳·法奇蒂（Floriana Facchetti）2，达娜·迪保罗（Dhanai di Paolo）2，大卫·塔贝内罗（David Tabernero）3，乔万娜·隆吉（Giovanna Lunghi）4，拉斐尔·埃斯特万（Rafael Esteban）1，玛丽亚·布蒂（Maria Buti）5，彼得罗·兰佩蒂科（Pietro Lampertico）6
隶属关系

    PMID：32703729 DOI：10.1016 / j.dld.2020.06.037

抽象

背景：为克服替诺福韦-二甲环戊砜的安全性限制，EASL指南建议将60岁以上或患有骨或肾脏疾病的慢性乙型肝炎患者改用替诺福韦-阿拉芬酰胺或恩替卡韦。

目的：估计在现实生活中将从治疗转换中受益的患者数量。

方法：在2017年12月31日之前接受替诺福韦-二甲氧哌啶的连续性乙型肝炎患者参加了两家欧洲医院的横断面研究。记录临床和病毒学数据；通过估计的肾小球滤过率，血清磷酸盐和肌酐，蛋白尿和蛋白尿评估肾功能。脊柱和股骨DEXA扫描检查骨骼受累情况。

结果：总共565例患者包括：62（18-91）岁，男性75％，白种人92％，HBeAg阴性92％，肝硬化40％。 55％的患者符合年龄标准（> 60岁）。老年患者有较高的肝硬化发生率（51％比26％，p <0.001），心血管疾病和肾功能不全。有36％的患者符合肾脏标准，更常见于无NA的患者（35％vs 21％，p = 0.001）； 17％患有骨病。总体而言，有66％的患者至少符合一项标准（如果经历过NA，则为71％），所有三个标准均为8％，年龄和肾脏标准为28％。

结论：根据EASL的建议，接受长期替诺福韦-二甲环戊胺长期治疗的患者中约有三分之二是恩替卡韦或替诺福韦-阿拉芬酰胺换药的候选人。

关键词：骨骼安全； ETV；乙肝病毒核苷类似物；肾脏安全； TAF； TDF。

版权所有©2020 Editrice Gastroenterologica Italiana S.r.l.由Elsevier Ltd.出版。保留所有权利。
利益冲突声明

竞争利益声明M. Buti和R. Esteban报告了来自AbbVie，Gilead Sciences，Bristol-Myers Squibb，Janssen和MSD的赠款支持和/或咨询与演讲费。 M. Riveiro-Barciela报告了吉利德科学公司的演讲费。 P.Lampertico是BMS，罗氏，吉利德科学公司，GSK，Abbvie，MSD，Arrowhead，Alnylam，Janssen，Spring Bank，Myr-pharma和Eiger的顾问委员会/发言人局。 A. Loglio是Myr-pharma的Gilead Sciences发言人小组。