中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 40 Issue 10
Oct.  2024
Turn off MathJax
Article Contents

Efficacy and safety of tenofovir alafenamide fumarate in patients with first-time hepatitis B virus-related decompensated cirrhosis

DOI: 10.12449/JCH241013
Research funding:

National Science and Technology Major Projects (2018ZX10302206-001-003)

More Information
  • Corresponding author: PAN Xiucheng, xzpxc68@126.com (ORCID: 0000-0001-9706-9458)
  • Received Date: 2024-01-10
  • Accepted Date: 2024-02-04
  • Published Date: 2024-10-25
  •   Objective  To investigate the application value of tenofovir alafenamide fumarate (TAF) in patients with first-time hepatitis B virus-related decompensated cirrhosis (HBV-DC) and its impact on renal function and lipid metabolism.  Methods  A total of 57 patients with first-time HBV-DC who were hospitalized and received TAF antiviral therapy in The Affiliated Hospital of Xuzhou Medical University from January 1, 2020 to December 31, 2022 were enrolled, and all of them received TAF antiviral therapy. Related data were collected at baseline and at weeks 12, 24, and 48 of treatment, including virological and serological indicators, liver and renal function, serum phosphorus, and blood lipids. The paired t-test or single group repeated measures ANOVA were used for comparison of normally distributed continuous data, the Friedman test was used for comparison of non-normally distributed continuous data, and the chi-square test or the Fisher’s exact test were used for categorical data.  Results  A total of 52 patients completed the 48 weeks of follow-up. After 12, 24, and 48 weeks of treatment, the patients achieving HBV DNA seroconversion accounted for 38.5%, 63.5%, and 84.6%, respectively; the alanine aminotransferase normalization rate were 71.2%, 82.7%, and 82.7%, respectively; the proportion of the patients with Child-Pugh class A disease increased to 55.8%, 73.1%, and 92.3%, respectively. Within the 48 weeks of treatment, there were significant increases in the levels of cystatin C (χ2=35.163, P<0.001) and serum phosphorus (F=8.600, P<0.001) and low-density lipoprotein cholesterol (χ2=10.064,P=0.018). The ratio of total cholesterol/high-density lipoprotein cholesterol decreased continuously from 3.61 (2.61~5.84) to 3.27 (2.70~4.36) (χ2=5.000, P=0.172).  Conclusion  TAF can rapidly inhibit HBV replication and significantly improve liver function in HBV-DC patients, with no significant impact on renal function. However, blood lipid should be closely monitored.

     

  • loading
  • [1]
    BERGUA JM, CABRERA C, BAÑAS H. Hepatitis B virus infection[J]. N Engl J Med, 2009, 360( 3): 304- 306. DOI: 10.1056/NEJMc082247.
    [2]
    Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35( 11): 2408- 2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.

    中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35( 11): 2408- 2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.
    [3]
    FATTOVICH G, BORTOLOTTI F, DONATO F. Natural history of chronic hepatitis B: Special emphasis on disease progression and prognostic factors[J]. J Hepatol, 2008, 48( 2): 335- 352. DOI: 10.1016/j.jhep.2007.11.011.
    [4]
    JANG JW, CHOI JY, KIM YS, et al. Effects of virologic response to treatment on short- and long-term outcomes of patients with chronic hepatitis B virus infection and decompensated cirrhosis[J]. Clin Gastroenterol Hepatol, 2018, 16( 12): 1954- 1963. e 3. DOI: 10.1016/j.cgh.2018.04.063.
    [5]
    JU YC, JUN DW, CHOI J, et al. Long term outcome of antiviral therapy in patients with hepatitis B associated decompensated cirrhosis[J]. World J Gastroenterol, 2018, 24( 40): 4606- 4614. DOI: 10.3748/wjg.v24.i40.4606.
    [6]
    TERRAULT NA, LOK ASF, MCMAHON BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance[J]. Hepatology, 2018, 67( 4): 1560- 1599. DOI: 10.1002/hep.29800.
    [7]
    CHOI J, KIM HJ, LEE J, et al. Risk of hepatocellular carcinoma in patients treated with entecavir vs tenofovir for chronic hepatitis B: A Korean nationwide cohort study[J]. JAMA Oncol, 2019, 5( 1): 30- 36. DOI: 10.1001/jamaoncol.2018.4070.
    [8]
    MARCELLIN P, GANE E, BUTI M, et al. Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: A 5-year open-label follow-up study[J]. Lancet, 2013, 381( 9865): 468- 475. DOI: 10.1016/S0140-6736(12)61425-1.
    [9]
    MURAKAMI E, WANG T, PARK Y, et al. Implications of efficient hepatic delivery by tenofovir alafenamide(GS-7340) for hepatitis B virus therapy[J]. Antimicrob Agents Chemother, 2015, 59( 6): 3563- 3569. DOI: 10.1128/AAC.00128-15.
    [10]
    HUANG T, NIU HY, ZHANG Q, et al. Current status and outlook of research on integrated Chinese and western medicine treatment of hepatitis B cirrhosis[J]. J Changchun Univ Chin Med, 2023, 39( 1): 113- 117. DOI: 10.13463/j.cnki.cczyy.2023.01.025.

    黄涛, 牛宏垚, 张倩, 等. 乙型肝炎肝硬化的中西医治疗研究现状及展望[J]. 长春中医药大学学报, 2023, 39( 1): 113- 117. DOI: 10.13463/j.cnki.cczyy.2023.01.025.
    [11]
    LUO X, QU Y, CAI XB, et al. Effects of antiviral therapy on the reversal of liver fibrosis[J]. J Clin Hepatol, 2022, 38( 11): 2596- 2598. DOI: 10.3969/j.issn.1001-5256.2022.11.032.

    罗昕, 曲颖, 蔡晓波, 等. 抗病毒治疗对肝纤维化逆转的影响[J]. 临床肝胆病杂志, 2022, 38( 11): 2596- 2598. DOI: 10.3969/j.issn.1001-5256.2022.11.032.
    [12]
    RUAN JJ, WEN SF, WANG X, et al. Influencing factors for recompensation in patients with first-time decompensated hepatitis B cirrhosis[J]. J Clin Hepatol, 2022, 38( 8): 1796- 1800. DOI: 10.3969/j.issn.1001-5256.2022.08.015.

    阮佳佳, 温世飞, 王霞, 等. 首次失代偿期乙型肝炎肝硬化患者获得再代偿的影响因素分析[J]. 临床肝胆病杂志, 2022, 38( 8): 1796- 1800. DOI: 10.3969/j.issn.1001-5256.2022.08.015.
    [13]
    SHIM JH, LEE HC, KIM KM, et al. Efficacy of entecavir in treatment-naïve patients with hepatitis B virus-related decompensated cirrhosis[J]. J Hepatol, 2010, 52( 2): 176- 182. DOI: 10.1016/j.jhep.2009.11.007.
    [14]
    LEE SK, SONG MJ, KIM SH, et al. Safety and efficacy of tenofovir in chronic hepatitis B-related decompensated cirrhosis[J]. World J Gastroenterol, 2017, 23( 13): 2396- 2403. DOI: 10.3748/wjg.v23.i13.2396.
    [15]
    HAN Y, ZENG AJ, LIAO HY, et al. The efficacy and safety comparison between tenofovir and entecavir in treatment of chronic hepatitis B and HBV related cirrhosis: A systematic review and Meta-analysis[J]. Int Immunopharmacol, 2017, 42: 168- 175. DOI: 10.1016/j.intimp.2016.11.022.
    [16]
    TSAI HJ, CHUANG YW, LEE SW, et al. Using the chronic kidney disease guidelines to evaluate the renal safety of tenofovir disoproxil fumarate in hepatitis B patients[J]. Aliment Pharmacol Ther, 2018, 47( 12): 1673- 1681. DOI: 10.1111/apt.14682.
    [17]
    TSAI MC, CHEN CH, TSENG PL, et al. Comparison of renal safety and efficacy of telbivudine, entecavir and tenofovir treatment in chronic hepatitis B patients: Real world experience[J]. Clin Microbiol Infect, 2016, 22( 1): 95. e1- 95. 95. e 7. DOI: 10.1016/j.cmi.2015.05.035.
    [18]
    AGARWAL K, BRUNETTO M, SETO WK, et al. 96 weeks treatment of tenofovir alafenamide vs. tenofovir disoproxil fumarate for hepatitis B virus infection[J]. J Hepatol, 2018, 68( 4): 672- 681. DOI: 10.1016/j.jhep.2017.11.039.
    [19]
    CHAN HLY, FUNG S, SETO WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of HBeAg-positive chronic hepatitis B virus infection: A randomised, double-blind, phase 3, non-inferiority trial[J]. Lancet Gastroenterol Hepatol, 2016, 1( 3): 185- 195. DOI: 10.1016/S2468-1253(16)30024-3.
    [20]
    YAO X, HUANG S, ZHOU H, et al. Clinical efficacy of antiviral therapy in patients with hepatitis B-related cirrhosis after transjugular intrahepatic portosystemic shunt[J]. World J Gastroenterol, 2021, 27( 30): 5088- 5099. DOI: 10.3748/wjg.v27.i30.5088.
    [21]
    SHLIPAK MG, MATTES MD, PERALTA CA. Update on cystatin C: Incorporation into clinical practice[J]. Am J Kidney Dis, 2013, 62( 3): 595- 603. DOI: 10.1053/j.ajkd.2013.03.027.
    [22]
    LIU QQ, YANG J, HU SS, et al. Advances in the pathogenesis, diagnosis, and treatment of renal injury in liver cirrhosis[J]. J Clin Hepatol, 2023, 39( 6): 1461- 1467. DOI: 10.3969/j.issn.1001-5256.2023.06.032.

    刘清清, 杨婧, 胡绍山, 等. 肝硬化肾损伤的发病机制与诊治进展[J]. 临床肝胆病杂志, 2023, 39( 6): 1461- 1467. DOI: 10.3969/j.issn.1001-5256.2023.06.032.
    [23]
    XU YK, DING Y, LI XC, et al. Cystatin C is a disease-associated protein subject to multiple regulation[J]. Immunol Cell Biol, 2015, 93( 5): 442- 451. DOI: 10.1038/icb.2014.121.
    [24]
    WANG FD, ZHOU J, LI LQ, et al. Improved bone and renal safety in younger tenofovir disoproxil fumarate experienced chronic hepatitis B patients after switching to tenofovir alafenamide or entecavir[J]. Ann Hepatol, 2023, 28( 5): 101119. DOI: 10.1016/j.aohep.2023.101119.
    [25]
    SUZUKI K, SUDA G, YAMAMOTO Y, et al. Effect of switching from tenofovir disoproxil fumarate to tenofovir alafenamide on lipid profiles in patients with hepatitis B[J]. PLoS One, 2022, 17( 1): e0261760. DOI: 10.1371/journal.pone.0261760.
    [26]
    JEONG J, SHIN JW, JUNG SW, et al. Tenofovir alafenamide treatment may not worsen the lipid profile of chronic hepatitis B patients: A propensity score-matched analysis[J]. Clin Mol Hepatol, 2022, 28( 2): 254- 264. DOI: 10.3350/cmh.2021.0314.
    [27]
    ARSENAULT BJ, BOEKHOLDT SM, KASTELEIN JJP. Lipid parameters for measuring risk of cardiovascular disease[J]. Nat Rev Cardiol, 2011, 8( 4): 197- 206. DOI: 10.1038/nrcardio.2010.223.
    [28]
    QUISPE R, ELSHAZLY MB, ZHAO D, et al. Total cholesterol/HDL-cholesterol ratio discordance with LDL-cholesterol and non-HDL-cholesterol and incidence of atherosclerotic cardiovascular disease in primary prevention: The ARIC study[J]. Eur J Prev Cardiol, 2020, 27( 15): 1597- 1605. DOI: 10.1177/2047487319862401.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(1)  / Tables(4)

    Article Metrics

    Article views (364) PDF downloads(41) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return