从恩替卡韦换用替诺福韦艾拉酚胺以维持慢性乙型肝炎的完全病毒学应答。

Switching from entecavir to tenofovir alafenamide for maintaining complete virological response in chronic hepatitis B.

作者信息

Ishido Shun, Tamaki Nobuharu, Uchihara Naoki, Suzuki Keito, Tanaka Yuki, Miyamoto Haruka, Yamada Michiko, Matsumoto Hiroaki, Nobusawa Tsubasa, Keitoku Taisei, Takaura Kenta, Tanaka Shohei, Maeyashiki Chiaki, Yasui Yutaka, Takahashi Yuka, Tsuchiya Kaoru, Nakanishi Hiroyuki, Itakura Jun, Kurosaki Masayuki, Izumi Namiki

机构信息

Department of Gastroenterology and Hepatology Musashino Red Cross Hospital Tokyo Japan.

出版信息

JGH Open. 2023 Jul 21;7(8):567-571. doi: 10.1002/jgh3.12950. eCollection 2023 Aug.

DOI:10.1002/jgh3.12950

PMID:37649865

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10463023/

Abstract

BACKGROUND AND AIM

Hepatocellular carcinoma development can be decreased by achieving and maintaining complete virological response (CVR) in chronic hepatitis B. However, it is unclear whether switching from entecavir (ETV) to tenofovir alafenamide (TAF) could achieve and maintain CVR in patients with low-level viremia (LLV; HBV DNA ≤ 3.3 log IU/mL) or occasional detectable HBV DNA during ETV treatment. Therefore, we aimed to examine whether the switching from ETV to TAF is effective in achieving CVR in patients with LLV or occasional detectable HBV DNA.

METHODS

This study comprised 45 patients who switched from ETV to TAF. All patients received ETV and TAF for >2 years, and the HBV DNA levels were measured every 3 months. Maintaining undetectable HBV DNA during 2-year period is defined as CVR. The primary endpoint is the CVR rate during ETV and TAF treatment.

RESULTS

The CVR rate for each of the 2 years of ETV and TAF therapy was 33.3% (15/45) and 68.9% (31/45, < 0.01), respectively, and the CVR rate increased by switching from ETV to TAF. In patients with occasional detectable HBV DNA during ETV treatment (22 patients), 15 achieved CVR and 7 maintained occasional detectable HBV DNA. In patients with LLV during ETV treatment (eight patients), three achieved CVR and five had occasional detectable HBV DNA.

CONCLUSION

Switching from ETV to TAF increases the CVR rate in patients with LLV or occasional detectable HBV DNA and could be an alternative treatment option.

摘要

背景与目的

在慢性乙型肝炎中，实现并维持完全病毒学应答（CVR）可降低肝细胞癌的发生风险。然而，对于低水平病毒血症（LLV；HBV DNA≤3.3 log IU/mL）或在恩替卡韦（ETV）治疗期间偶尔可检测到HBV DNA的患者，从ETV转换为替诺福韦艾拉酚胺（TAF）是否能实现并维持CVR尚不清楚。因此，我们旨在研究从ETV转换为TAF对LLV或偶尔可检测到HBV DNA的患者实现CVR是否有效。

方法

本研究纳入了45例从ETV转换为TAF的患者。所有患者接受ETV和TAF治疗均超过2年，每3个月检测一次HBV DNA水平。在2年期间维持HBV DNA检测不到定义为CVR。主要终点是ETV和TAF治疗期间的CVR率。

结果

ETV和TAF治疗的2年中，每年的CVR率分别为33.3%（15/45）和68.9%（31/45，P<0.01），从ETV转换为TAF后CVR率有所提高。在ETV治疗期间偶尔可检测到HBV DNA的患者（22例）中，15例实现了CVR，7例维持偶尔可检测到HBV DNA。在ETV治疗期间为LLV的患者（8例）中，3例实现了CVR，5例偶尔可检测到HBV DNA。