替诺福韦艾拉酚胺可降低慢性乙型肝炎患者的肝脏硬度

StephenW

替诺福韦艾拉酚胺可降低慢性乙型肝炎患者的肝脏硬度
斯蒂芬·帕迪拉
21 小时前
替诺福韦艾拉酚胺可降低慢性乙型肝炎患者的肝脏硬度

一项研究表明，使用核苷（酸）类似物（NUC）艾拉酚胺替诺福韦（TAF）治疗 2 年可改善慢性乙型肝炎（CHB）患者的肝脏硬度，包括晚期肝纤维化患者。 IDWeek 2022 在美国华盛顿特区举行。

此外，基线肝硬度和丙氨酸转氨酶 (ALT) 可预测接受 TAF 治疗的 CHB 患者的肝硬度降低。

美国马里兰州巴尔的摩市马里兰大学医学院临床护理和研究主任 Shyam Kottilil 博士领导的研究人员说：“这可能反映了在 NUC 开始时存在肝脏炎症的情况下对纤维化阶段的高估。”

“因此，在开始 NUC 治疗后重复 FibroScan 将是有用的，特别是在 ALT 升高的人群中，用于指导 CHB 护理，”他们补充说。

在这项研究中，Kottilil 及其同事对在巴尔的摩马里兰大学注册的患者进行了为期 2 年的每日 25 毫克 TAF 治疗。在基线和第 2 年使用 FibroScan 测量肝脏硬度。轻度 (F0/F1) 纤维化定义为 ≤7.4 kPa，晚期纤维化定义为 ≥7.5 kPa。

然后，研究人员使用多元线性回归评估了从基线到第 2 年的肝脏硬度变化的相关性。 p 值 <0.05 被认为是显着的。

60 名 CHD 患者完成了研究。其中，29 人将治疗从另一个 NUC 转换为 TAF（转换组），而 31 人在基线时未接受 NUC 治疗（无 NUC 组：17 人初治，14 人先前 NUC）。 [IDWeek 2022，摘要 1236]

无 NUC 组显示出比转换组更高的基线 ALT（53.5 对 30.2 IU/ml；p<0.007）。大多数（67.2%）患者在基线时也出现轻度纤维化，而 19 人出现晚期纤维化。在患有晚期纤维化的患者中，14 人至少改善了一个疾病阶段，但 5 人没有变化。

非 NUC 组患者的肝硬度有所改善（硬度的平均变化 ‒1.2161 kPa；p=0.02），但转换组患者的肝硬度没有改善。在亚组分析中，非 NUC 组的晚期纤维化患者的肝脏硬度也有所降低，但转换组的患者则没有。

值得注意的是，较高的基线 ALT（rho，-0.3；p=0.005）和基线肝硬度（rho，-0.7；p<0.0001）是肝脏硬度改善的有力预测指标。

研究人员说：“在 NUC 治疗 2 年后，基线时肝脏硬度增加，因此纤维化与肝脏硬度降低，因此肝脏硬度降低有关。”

这些发现与中国慢性乙型肝炎患者早期研究的结果一致，其中基线时较高的肝脏硬度值有助于肝脏硬度的更大降低。 [Exp Ther Med 2017;13:1169-1175]

“在全球范围内，有 2.96 亿人感染了慢性乙型肝炎并面临肝硬化和肝细胞癌的风险。使用 TAF 等 [an NUC] 进行抑制治疗可降低肝硬化和癌症的风险，”研究人员说。

“瞬时弹性成像测量肝脏硬度并用于监测 CHB 中的肝纤维化，”他们补充说。

StephenW

Tenofovir alafenamide reduces liver stiffness in CHB patients
Stephen Padilla
21 hours ago
Tenofovir alafenamide reduces liver stiffness in CHB patients

Treatment with the nucleos(t)ide analogue (NUC) tenofovir alafenamide (TAF) for 2 years leads to improvements in liver stiffness among patients with chronic hepatitis B (CHB), including those with advanced liver fibrosis, according to a study presented at the IDWeek 2022 in Washington, DC, US.

In addition, baseline liver stiffness and alanine transaminase (ALT) are predictive of liver stiffness reduction in CHB patients treated with TAF.

“This may reflect an overestimation of fibrosis stage in the presence of liver inflammation at NUC initiation,” said the researchers led by Dr Shyam Kottilil, Director Clinical Care and Research, University of Maryland School of Medicine, Baltimore, Maryland, US.

“Repeating FibroScan after initiation of NUC treatment would therefore be useful, especially in people with elevated ALT, for guiding CHB care,” they added.

In the study, Kottilil and colleagues treated patients enrolled at the University of Maryland, Baltimore, with TAF 25 mg daily for 2 years. Liver stiffness was measured using FibroScan at baseline and year 2. Mild (F0/F1) fibrosis was defined as ≤7.4 kPa and advanced fibrosis as ≥7.5 kPa.

The researchers then assessed the correlates of liver stiffness change from baseline to year 2 using multiple linear regression. A p-value of <0.05 was deemed significant.

Sixty patients with CHD completed the study. Of these, 29 switched treatments from another NUC to TAF (switch group), while 31 were not treated with NUC at baseline (No NUC group: 17 treatment-naïve, 14 prior NUC). [IDWeek 2022, abstract 1236]

The no-NUC group showed a higher baseline ALT than the switch group (53.5 vs 30.2 IU/ml; p<0.007). Majority (67.2 percent) of the patients also presented with mild fibrosis at baseline, while 19 had advanced fibrosis. Among patients with advanced fibrosis, 14 had an improvement by at least one disease stage, but five showed no change.

Liver stiffness improved among patients in the no-NUC group (mean change in stiffness ‒1.2161 kPa; p=0.02) but not among those in the switch group. In subgroup analysis, patients with advanced fibrosis in the no-NUC group also had a reduction in liver stiffness, but not those in the switch group.

Of note, higher baseline ALT (rho, ‒0.3; p=0.005) and baseline liver stiffness (rho, ‒0.7; p<0.0001) were robust predictors of improvements in liver stiffness.

“Increased liver stiffness, and therefore fibrosis, at baseline was associated with greater reductions in liver stiffness, and therefore liver stiffness, after 2 years of NUC therapy,” the researchers said.

These findings were consistent with those of an earlier study in Chinese patients with CHB, in which higher liver stiffness values at baseline contributed to a greater decrease in liver stiffness. [Exp Ther Med 2017;13:1169-1175]

“Globally, 296 million people are infected with CHB and at risk for cirrhosis and hepatocellular carcinoma. Suppressive therapy with [an NUC] such as TAF reduces risk of cirrhosis and cancer,” the researchers said.

“Transient elastography measures liver stiffness and is used to monitor liver fibrosis in CHB,” they added.

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