Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan.
Division of Hepatogastroenterology, Department of Internal Medicine, Linkuo Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan.
Dig Liver Dis. 2023 Jun;55(6):771-777. doi: 10.1016/j.dld.2023.01.154. Epub 2023 Feb 1.
BACKGROUND/AIMS: The incidence and relapse pattern in patients stopping tenofovir alafenamide (TAF), a prodrug of tenofovir which is more concentrated in hepatocytes, is unknown.
HBeAg-negative CHB patients stopping tenofovir disoproxil fumarate (TDF) (off-TDF) or who had switched to TAF more than 3 months before discontinuation (off-TAF) were recruited. The propensity score-matching method (PSM) was used, creating a ratio of 1:3 between the off-TAF versus the off-TDF groups to adjust for associated factors.
After PSM, 180 off-TDF and 60 off-TAF patients were analyzed. The cumulative rates of virological and clinical relapse at 52 weeks were 75.1% and 58.5% respectively in the off-TDF group and 91.1% and 61.6% in the off-TAF group. Patients in the off-TAF group had significantly higher rates of virological relapse than those in the off-TDF group (p = 0.021), but not clinical relapse (p = 0.785). Multivariate cox regression analysis showed that off-TAF group was an independent factor for virological relapse, but not clinical relapse. Severity of clinical relapse and hepatic decompensation rate were comparable between off-TDF and off-TAF groups CONCLUSIONS: The off-TAF group had a higher virological relapse rate than the off-TDF group. The difference in clinical relapse pattern and severity was not clinically important between the two groups.
背景/目的：停止使用替诺福韦艾拉酚胺（TAF）——一种更集中在肝细胞中的替诺福韦前体药物——的患者的发病率和复发模式尚不清楚。
招募了停止使用富马酸替诺福韦二吡呋酯（TDF）（停药 TDF）或在停药前 3 个月以上转换为 TAF（停药 TAF）的 HBeAg 阴性 CHB 患者。使用倾向评分匹配法（PSM），在停药 TAF 组与停药 TDF 组之间创建 1:3 的比例，以调整相关因素。
经过 PSM，分析了 180 例停药 TDF 和 60 例停药 TAF 患者。停药 TDF 组和停药 TAF 组在第 52 周时病毒学和临床复发的累积发生率分别为 75.1%和 58.5%以及 91.1%和 61.6%。停药 TAF 组的病毒学复发率明显高于停药 TDF 组（p=0.021），但临床复发率无差异（p=0.785）。多变量 cox 回归分析显示，停药 TAF 组是病毒学复发的独立因素，但不是临床复发的独立因素。停药 TDF 组和停药 TAF 组的临床复发严重程度和肝失代偿率相当。
停药 TAF 组的病毒学复发率高于停药 TDF 组。两组之间的临床复发模式和严重程度的差异在临床上并不重要。
