慢性乙型肝炎患者改用替诺福韦阿拉芬酰胺后72周的骨和肾脏

StephenW

Bone and renal safety profile at 72 weeks after switching to tenofovir alafenamide in chronic hepatitis B patients
Brian T Lee  1   2 , Mimi Chang  1 , Carolina Lim  1 , Ho S Bae  1 , Tse-Ling Fong  1   2
Affiliations
Affiliations

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

    PMID: 33553665 PMCID: PMC7857293 DOI: 10.1002/jgh3.12481

Free PMC article
Abstract

Background and aim: Tenofovir disoproxil fumarate (TDF) has been efficacious in treating chronic hepatitis B (CHB), but long-term use is accompanied by a decline in renal function and bone mineral density (BMD). Tenofovir alefanamide (TAF) is a prodrug of tenofovir, with similar efficacy in CHB but with fewer side effects than TDF. Recent studies on patients who underwent the switch from TDF to TAF have shown improved bone and renal profiles from 24 to 48 weeks of follow-up.

Methods: This study provides follow-up at 72 weeks in a real-world cohort of 61 Asian CHB patients who were switched from TDF to TAF. All patients had been treated with TDF for at least 12 months with hepatitis B virus DNA <21 IU/mL prior to switch.

Results: Improvements in proximal tubular function, measured by urine beta-2-microglobulin to creatinine and retinol-binding protein to creatinine ratios, were sustained at 72 weeks (P < 0.01). Renal function showed decline at 72 weeks compared to baseline (GFRCG 90.9 vs 96.3 mL/min, P < 0.01). Improvement in hip BMD was sustained at 72 weeks (mean % change of 17.7% from baseline, P < 0.01). However, spine BMD showed discordance, with initial improvement at 24 weeks (3.3% from week 0, P < 0.01) but regression at 72 weeks (-0.6% from week 0, P = NS). Interestingly, there was a slight increase in weight and BMI after 72 weeks (P < 0.01).

Conclusions: CHB patients who switch from long-term TDF to TAF therapy show sustained improvement in proximal tubular function and hip BMD. Weight gain was noted, and long-term studies are needed to evaluate its effect on patient outcomes.

Keywords: bone mineral density; chronic hepatitis B; proximal tubular function; switch; tenofovir alafenamide.

© 2020 The Authors. JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

StephenW

慢性乙型肝炎患者改用替诺福韦阿拉芬酰胺后72周的骨和肾脏安全性
李安健1 2，张咪咪1，卡罗琳娜1，何诗贝1，方谢玲1 2
隶属关系
隶属关系

    1个
    在圣文森特医疗中心洛杉矶加利福尼亚美国的亚太肝脏中心。
    2
    美国南加州大学洛杉矶分校凯克医学院胃肠道和肝病科。

    PMID：33553665 PMCID：PMC7857293 DOI：10.1002 / jgh3.12481

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背景与目的：替诺福韦富马酸替索罗非酯（TDF）在治疗慢性乙型肝炎（CHB）方面非常有效，但长期使用会伴随肾功能和骨矿物质密度（BMD）下降。替诺福韦alefanamide（TAF）是替诺福韦的前药，在CHB中疗效相似，但副作用比TDF少。最近对从TDF转换为TAF的患者进行的研究表明，从随访24到48周，骨骼和肾脏的状况得到改善。

方法：本研究对来自真实世界的61名亚洲人CHB患者（从TDF改为TAF）进行了为期72周的随访。所有患者在换药前均接受过TDF至少12个月的乙型肝炎病毒DNA <21 IU / mL治疗。

结果：通过尿β-2-微球蛋白与肌酐和视黄醇结合蛋白与肌酐的比值测量，近端肾小管功能持续改善至72周（P <0.01）。与基线相比，肾功能在72周时下降（GFRCG 90.9 vs 96.3 mL / min，P <0.01）。髋关节BMD的改善在72周时得以持续（相对于基线的平均百分比变化为17.7％，P <0.01）。但是，脊柱BMD表现出不一致，最初改善在24周时（从第0周起为3.3％，P <0.01），而在72周时有所改善（从第0周起为-0.6％，P = NS）。有趣的是，72周后体重和BMI略有增加（P <0.01）。

结论：从长期TDF转向TAF治疗的CHB患者显示出近端肾小管功能和髋部BMD持续改善。注意到体重增加，需要长期研究以评估其对患者预后的影响。

关键词：骨矿物质密度慢性乙型肝炎近端肾小管功能；转变;替诺福韦阿拉芬酰胺。

©2020作者。 JGH Open：《胃肠病学和肝病学杂志》和John Wiley＆Sons Australia，Ltd.出版的开放式胃肠病学和肝病学期刊。

StephenW

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/jgh3.12481