Sequential HBV treatment with tenofovir alafenamide for patients with chronic hepatitis B: week 96 results from a real-world, multicenter cohort study

• DOI: 10.1007/s12072-021-10295-3
• Publication Date: 2022-01-25T03:02:49Z
• Authors: Eiichi Ogawa; Makoto Nakamuta; Toshimasa Koyanagi; Aritsune Ooho; Norihiro Furusyo; Eiji Kajiwara; Kazufumi Dohmen; Akira Kawano; Takeaki Satoh; Kazuhiro Takahashi; Koichi Azuma; Nobuyuki Yamashita; Naoki Yamashita; Rie Sugimoto; Hiromasa Amagase; Masami Kuniyoshi; Yasunori Ichiki; Chie Morita; Masaki Kato; Shinji Shimoda; Hideyuki Nomura; Jun Hayashi
• Keywords: Male; 0301 basic medicine; Hepatitis B virus; Alanine; Hepatitis B Surface Antigens; Adenine; Antiviral Agents; Cohort Studies; 03 medical and health sciences; Hepatitis B, Chronic; Treatment Outcome; DNA, Viral; Humans; Female; Renal Insufficiency, Chronic; Tenofovir; Retrospective Studies

Outcome data of sequential hepatitis B virus treatment with tenofovir alafenamide (TAF) are limited. We aimed to assess the effectiveness and renal safety of TAF in chronic hepatitis B (CHB) patients who were previously treated with entecavir (ETV), tenofovir disoproxil fumarate (TDF), or a nucleos(t)ide analogue (NA) combination.This multicenter, retrospective, cohort study included 458 consecutive CHB patients who switched to TAF monotherapy after at least 2 years of treatment with another NA. The longitudinal virological/laboratory responses were evaluated up to 96 weeks after switchover. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2.The proportions of complete viral suppression (CVS) (HBV DNA < 20 IU/mL) at week 96 were 99.0%, 98.5%, and 98.4% in the prior ETV (n = 198), TDF (n = 137), and NA combination (n = 123) groups, respectively. Almost all patients with HBV DNA of 20-2000 IU/mL at baseline achieved CVS at week 96. On multivariable generalized estimated equation analysis, a low quantitative hepatitis surface antigen (qHBsAg) level at baseline was associated with a lower follow-up qHBsAg level (coefficient 0.81, p < 0.001). The eGFR showed greater improvement in patients with CKD compared to those without (coefficient 21.7, p < 0.001). However, the increase of eGFR reached a peak between weeks 24 and 48.Based on this longitudinal data analysis up to 96 weeks, sequential NA therapy with a switch to TAF is a good option to achieve high viral suppression and renal safety.