Huynh Tung, Bui Delana MyAn, Zhou Tina Xiwen, Hu Ke-Qin
Department of Pharmacy, University of California Irvine Medical Center, Orange, CA 92868, United States.
University of Houston, Houston, TX 77204, United States.
World J Hepatol. 2024 Jul 27;16(7):1009-1017. doi: 10.4254/wjh.v16.i7.1009.
Both tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF) are the first-line treatments for chronic hepatitis B (CHB). We have showed switching from TDF to TAF for 96 weeks resulted in further alanine aminotransferase (ALT) improvement, but data remain lacking on the long-term benefits of TDF switching to TAF on hepatic fibrosis.
To assess the benefits of TDF switching to TAF for 3 years on ALT, aspartate aminotransferase (AST), and hepatic fibrosis improvement in patients with CHB.
A single center retrospective study on 53 patients with CHB who were initially treated with TDF, then switched to TAF to determine dynamic patterns of ALT, AST, AST to platelet ratio index (APRI), fibrosis-4 (FIB-4) scores, and shear wave elastography (SWE) reading improvement at switching week 144, and the associated factors.
The mean age was 55 (28-80); 45.3%, males; 15.1%, clinical cirrhosis; mean baseline ALT, 24.8; AST, 25.7 U/L; APRI, 0.37; and FIB-4, 1.66. After 144 weeks TDF switching to TAF, mean ALT and AST were reduced to 19.7 and 21, respectively. From baseline to switching week 144, the rates of ALT and AST < 35 (male)/25 (female) and < 30 (male)/19 (female) were persistently increased; hepatic fibrosis was also improved by APRI < 0.5, from 79.2% to 96.2%; FIB-4 < 1.45, from 52.8% to 58.5%, respectively; mean APRI was reduced to 0.27; FIB-4, to 1.38; and mean SWE reading, from 7.05 to 6.30 kPa after a mean of 109 weeks switching. The renal function was stable and the frequency of patients with glomerular filtration rate > 60 mL/min was increased from 86.5% at baseline to 88.2% at switching week 144.
Our data confirmed that switching from TDF to TAF for 3 years results in not only persistent ALT/AST improvement, but also hepatic fibrosis improvement by APRI, FIB-4 scores, as well as SWE reading, the important clinical benefits of long-term hepatitis B virus antiviral treatment with TAF.
替诺福韦艾拉酚胺（TAF）和替诺福韦酯（TDF）均为慢性乙型肝炎（CHB）的一线治疗药物。我们已表明，从TDF转换为TAF治疗96周可进一步改善丙氨酸氨基转移酶（ALT），但关于TDF转换为TAF对肝纤维化的长期益处的数据仍然缺乏。
评估CHB患者从TDF转换为TAF治疗3年对ALT、天冬氨酸氨基转移酶（AST）及肝纤维化改善情况的益处。
一项单中心回顾性研究，纳入53例最初接受TDF治疗，随后转换为TAF治疗的CHB患者，以确定在第144周转换时ALT、AST、AST与血小板比值指数（APRI）、纤维化-4（FIB-4）评分及剪切波弹性成像（SWE）读数的动态变化模式，以及相关因素。
平均年龄为55岁（28 - 80岁）；男性占45.3%；临床肝硬化患者占15.1%；平均基线ALT为24.8；AST为25.7 U/L；APRI为0.37；FIB-4为1.66。从TDF转换为TAF治疗144周后，平均ALT和AST分别降至19.7和21。从基线到第144周转换时，ALT和AST < 35（男性）/25（女性）以及< 30（男性）/19（女性）的比例持续增加；肝纤维化也得到改善，APRI < 0.5的比例从79.2%升至96.2%；FIB-4 < 1.45的比例分别从52.8%升至58.5%；平均APRI降至0.27；FIB-4降至1.38；转换后平均109周时，平均SWE读数从7.05降至6.30 kPa。肾功能稳定，肾小球滤过率> 60 mL/min的患者比例从基线时的86.5%增至第144周转换时的88.2%。
我们的数据证实，CHB患者从TDF转换为TAF治疗3年不仅能持续改善ALT/AST，还能通过APRI、FIB-4评分以及SWE读数改善肝纤维化，这是TAF长期抗乙肝病毒治疗的重要临床益处。
