Published online Jul 27, 2024. doi: 10.4254/wjh.v16.i7.1009
Revised: June 3, 2024
Accepted: June 27, 2024
Published online: July 27, 2024
Processing time: 137 Days and 2 Hours
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.
Core Tip: Tenofovir disoproxil fumarate (TDF), entecavir, and tenofovir alafenamide (TAF) have been used as first-line therapy for chronic hepatitis B. In this study, we assessed the effect of TDF switching to TAF for 3 years (144 weeks) on dynamic changes of alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST to platelet ratio index (APRI), fibrosis-4 (FIB-4) scores and shear wave elastography (SWE) reading. Our study demonstrated that switching from TDF to TAF for 3 years results in persistent mean ALT and AST reduction with high rate of normalization, and also hepatic fibrosis improvement assessed by mean APRI and FIB-4 scores, as well as SWE reading.