Therapeutic efficacy of switching to tenofovir alafenamide fumarate in entecavir-treated chronic hepatitis B patients with low-level viremia

Abstract

Abstract: Objective To analyze the curative effect of switching treatment to tenofovir alafenamide fumarate (TAF) in chronic hepatitis B (CHB) patients with low-level viremia (LLV) after entecavir (ETV) treatment. Methods A retrospective analysis was conducted of 138 patients with CHB who were diagnosed and managed at our institution from January 2022 to December 2023. They were divided into ETV group (n=68) and TAF group (n=70) according to whether the patients continued to use ETV or switched to TAF. The changes of HBV markers, liver and kidney function levels before and after treatment were compared between the two groups, and the complete virological response (CVR) rate, the HBeAg negativity rate and ALT normalization rate were analyzed. Results After treatment, the HBV markers such as HBV DNA and HBsAg in TAF group and ETV group decreased significantly after 48 weeks of treatment (P<0.05). Compared with ETV group, HBV markers decreased more significantly after 48 weeks of treatment (P<0.05). After treatment, the liver function of TAF group and ETV group decreased significantly after 48 weeks of treatment (P<0.05). Compared with the ETV group, the liver function decreased significantly after 48 weeks of treatment (P<0.05). After treatment, the serum creatinine and β2- microglobulin in TAF group and ETV group were significantly decreased after 48 weeks of treatment, while eGFR was significantly increased in TAF group (P<0.05). Compared with ETV group, the improvement of renal function was more significant after 48 weeks of treatment (P<0.05). After treatment, the CVR rate and HBeAg negativity rate in TAF group were significantly higher than those in ETV group (P<0.05), but the normalization rate of ALT between the two groups was not statistically significant (P>0.05). Conclusion TAF has obvious advantages in antiviral efficacy of CHB patients, especially in complete virology inhibition, negative HBeAg conversion and improvement of liver function and renal function.

Key words: Chronic hepatitis B, Low-level viremia, Entecavir, Tenofovir alafenamide

WU Yu, LI Yong-wei, ZHOU De-bing. Therapeutic efficacy of switching to tenofovir alafenamide fumarate in entecavir-treated chronic hepatitis B patients with low-level viremia[J]. Chinese Hepatolgy, 2025, 30(7): 963-966.

References

[1] Yuan Y Q, Chen Q Q. Review on article of preoperative prediction in chronic hepatitis B virus patients using spectral computed tomography and machine learning[J]. World J Gastroenterol, 2024, 30(38):4239-4241.
[2] Liaw Y F. Perspectives on outcome prediction in patients with chronic hepatitis B virus infection[J]. Gastro Hep Adv, 2023, 3(2):162-166.
[3] Ray G. Long-term entecavir therapy of chronic hepatitis B in real-life setting-Importance of quantitative HBsAg level[J]. Indian J Gastroenterol, 2024, 43(3):652-659.
[4] Huang L, Zhang H, Kang X, et al. Efficacy of pegylated interferon α-2b plus entecavir therapy and predictors of treatment success in children with chronic hepatitis B[J]. Front Immunol, 2023, 14:1282922.
[5] Li Z B, Chen D D, Jia Y F, et al. Risk factors related to low-level viraemia in chronic hepatitis B patients receiving entecavir treatment[J]. Front Cell Infect Microbiol, 2024, 14:1413589.
[6] Chen H, Fu J J, Li L, et al. Risk factors of low-level viremia in chronic hepatitis B patients receiving entecavir monotherapy: a retrospective cohort study[J]. J Gastroenterol Hepatol, 2024, 39(1):180-184.
[7] Sanai F M, Aljawad M, Alghamdi AS, et al. Long-term health and economic benefits of switching to tenofovir alafenamide versus continuing on entecavir in chronic hepatitis B patients with low-level viremia in Saudi Arabia[J]. Saudi J Gastroenterol, 2024, 30(1):23-29.
[8] Cao F, Fan T, Jiang X, et al. Effects of tenofovir alafenamide fumarate on serum lipid profiles in patients with chronic hepatitis B[J]. Virol J, 2024, 21(1):234.
[9] Zhang Q, Xu J, Liu D, et al. Comparative efficacy and safety of tenofovir amibufenamide vs tenofovir alafenamide in the initial 48-week treatment of high viral load chronic hepatitis B: a single-centre retrospective study[J]. Antivir Ther, 2024, 29(5):13596535241284226.
[10] 中华医学会肝病学分会和感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 实用肝脏病杂志, 2023, 26(3)S18-39.
[11] 中华医学会肝病学分会. 扩大慢性乙型肝炎抗病毒治疗的专家意见[J]. 中华肝脏病杂志, 2022, 30(2):131-136.
[12] Pan C Q, Zhu L, Yu A S, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for preventing vertical transmission in chronic hepatitis B mothers: a systematic review and meta-analysis[J]. Clin Infect Dis, 2024, 79(4):953-964.
[13] Hou J, Ning Q, Duan Z, et al. Five-year treatment with tenofovir alafenamide achieves high rates of viral suppression, alanine aminotransferase normalization, and favorable bone and renal safety in Chinese chronic hepatitis B patients[J]. J Clin Transl Hepatol, 2024, 12(5):469-480.
[14] Nam H, Han J W, Lee S K, et al. Switching from tenofovir disoproxil fumarate to tenofovir alafenamide in virologically suppressed patient with chronic hepatitis B[J]. J Gastroenterol Hepatol, 2024, 39(8):1673-1683.
[15] Janssen H L A, Lim Y S, Lampertico P, et al. Switching to tenofovir alafenamide in patients with virologically suppressed chronic hepatitis B and renal or hepatic impairment: final week 96 results from an open-label, multicentre, phase 2 study[J]. Lancet Gastroenterol Hepatol, 2024, 9(8):718-733.
[16] Tanaka M, Akahane T, Kawaratani H, et al. Effects of entecavir and tenofovir alafenamide fumarate treatment on renal function in Japanese elderly patients with chronic hepatitis B[J]. Hepatol Res, 2024, 54(3):252-260.
[17] 薛李娜, 诸国兵, 吴琳霖, 等. TAF治疗ETV经治的低病毒血症慢性乙型肝炎患者疗效研究[J]. 实用肝脏病杂志, 2024, 27(4):519-522.