Clinical effect and discussion on the solution of poor response of tenofovir alafenamide fumarate and tenofovir dixil in the treatment of chronic hepatitis B patients undergoing initial treatment

Li Qingmei; Jiang Jianning; Su Minghua; Su Tumei; Yin Qianbing; Hu Bobin; Wang Rongming; Liang Hengkai; Wei Lu; Feng Yanfei

doi:10.3760/j.issn.1673-4777.2024.01.014

Abstract：Objective To investigate the efficacy of tenofovir alafenamide fumarate(TAF)and tenofovir dixil(TDF)and the solution of poor response in previously untreated chronic hepatitis B(CHB)patients.Methods The clinical data of 163 CHB patients admitted to Department of Infectious Diseases,the First Affiliated Hospital of Guangxi Medical University from January 2018 to June 2022 were collected.They were divided into TDF group(85 cases)and TAF group(78 cases)according to different drugs.Factors influencing hepatitis B virus(HBV)DNA response were analyzed by Logistic regression analysis,and baseline HBV DNA,baseline alanine aminotransferase(ALT),drug,gender,and baseline hepatitis B e antigen(HBeAg)were stratified analyzed.The outcomes of CHB patients who did not receive complete virology response(HBV DNA＜20 kIU/L)after 48 weeks of treatment were analyzed.Results Multivariate Logistic regression analysis showed that gender,baseline ALT,baseline HBV DNA and baseline HBeAg were the influencing factors of complete viral response,of which female,abnormal baseline ALT,low baseline HBV DNA load and negative baseline HBeAg were more likely to obtain complete virological response(all P＜0.05).After 48 weeks of treatment,72.4％(118/163)patients achieved complete virological response,complete virological response rate was higher in the TAF group than that in the TDF group(P＜0.05).The complete virological response rate in the group of baseline HBV DNA ≤2 × 105 kIU/L was higher than that in the group of baseline HBV DNA＞2 × 105 kIU/L(P＜0.001).For patients who did not obtain a complete virological response after 48 weeks of treatment,78.6％(11/14)obtained a complete virological response after followed 48 weeks of treatment by the original regimen.A complete virological response was achieved by 81.0％(17/21)after 48 weeks of conversion or addition to another nucleoside(acid)antiviral.Conclusions Both TDF and TAF can effectively inhibit HBV DNA replication,and the efficacy of TAF is not inferior to that of TDF.The level of HBV DNA is an important factor in the achievement of complete virological response.For patients with poor response after 48 weeks of treatment,drugs should be changed in time or the drug dose should be increased to promote the rate of complete virological response and reduce the occurrence of drug resistance.