AUTHOR=Peng Wenting , Gu Huimin , Cheng Da , Chen Keyu , Wu Cichun , Jiang Chuan , Liu Jinqing , Peng Shifang , Fu Lei 

TITLE=Tenofovir alafenamide versus entecavir for treating hepatitis B virus-related acute-on-chronic liver failure: real-world study

JOURNAL=Frontiers in Microbiology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2023.1185492

DOI=10.3389/fmicb.2023.1185492

ISSN=1664-302X

ABSTRACT=<sec><title>Background and aims</title><p>Real-world data regarding hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) patients receiving tenofovir alafenamide (TAF) as an antiviral drug are limited. Hence, we evaluated the efficacy and kidney safety of TAF among this population.</p></sec><sec><title>Methods</title><p>A total of 272 HBV-related ACLF patients hospitalized at Xiangya Hospital of Central South University were enrolled in this retrospective research. All patients received antiviral therapy with TAF (<italic>n</italic> = 100) or ETV (<italic>n</italic> = 172) and comprehensive medical treatments.</p></sec><sec><title>Results</title><p>Through 1:1 propensity score matching, 100 patients were finally included in each group. At week 48, the survival rates without transplantation of the TAF group and ETV group were 76.00 and 58.00%, separately (<italic>P</italic> = 0.007). After 4 weeks of treatment, the TAF treatment group exhibited a significantly decline in HBV DNA viral load (<italic>P</italic> = 0.029). The mean estimated glomerular filtration rate was apparently improved in the TAF group compared with the ETV group (TAF 5.98 ± 14.46 vs. ETV 1.18 ± 18.07 ml/min/1.73 m<sup>2</sup>) (<italic>P</italic> &lt; 0.05). There were 6 patients in TAF group and 21 patients in ETV group with chronic kidney disease (CKD) stage progression ≥ 1. By contrast, the ETV treatment group has a greater risk of renal function progression in CKD 1 stage patients (<italic>P</italic> &lt; 0.05).</p></sec><sec><title>Conclusion</title><p>This real-world clinical study showed that TAF is more effective than ETV in reducing viral load and improving survival rate in HBV-ACLF patients and the risk of renal function decline is lower.</p></sec><sec><title>Clinical trial registration</title><p><ext-link ext-link-type="uri" xlink:href="https://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">https://ClinicalTrials.gov</ext-link>, identifier NCT05453448.</p></sec>