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- 저자 : ( Tse-ling Fong ) (검색결과 1 건)
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( Tse-ling Fong ),( Brian Lee ),( Andy Tien ),( Mimi Chang ),( Carolina Lim ),( Ho S. Bae ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: Tenofovir alafenamide (TAF) is a novel prodrug that re -duces tenofovir plasma levels by 90% compared to tenofovir disoproxil fumarate (TDF), resulting in decreased bone mineral density (BMD) loss and renal toxicity. We aimed to study chang es in BMD and markers of renal function of chronic hepatitis B (CHB) patients previously treated with TDF who were switched to TAF. Methods: This was a prospective single-arm open-label study of 75 CHB patients treated with TDF 300 mg daily who were switched to TAF 25 mg daily and followed for 24 weeks. All patients had been treated with TDF for at least 12 months and had HBV DNA < 21 IU/mL at the time of switch. BMD and markers of renal function were taken on the day of switch and repeated after 12 and 24 weeks of TAF treatment. Results: BMD significantly increased after switch from TDF to TAF from baseline to week 12 and remained stable at week 24. Mean percent changes from baseline to week 12 in hip and spine BMDs significantly increased (+ 12.9% and +2.4%, respectively). There were significantly more patients with gains in hip (86%) or spine (76%) BMD than patients who experi enced loss (11% and 25%, respectively). No significant change in BMD was seen between week 12 and 24. There was no significant difference in eGFR<sub>CG</sub> from baseline to week 24. Sig nificant improvement was observed in urinary beta-2 micro globulin/creatinine ratio between baseline and week 12 that remained through week 24 (median change from baseline to week 12 and 24; 1.5, 1.0 and 1.1 mcg/g respectively; P<0.01). Similar changes were observed with retinol binding protein/cre atinine ratio at from baseline to week 12 and 24 (median change from baseline to week 12 and 24; 1.7, 1.3 and 1.4 mcg/g re spectively; P<0.01). There was significant increase in fractional excretion of phosphate from baseline to week 24 (11.9 to 14.0; P<0.05). Phosphate threshold for renal tubular reabsorption de creased from baseline to week 12 (2.8 to 2.6 mg/dL). Conclusions: Switching from long-term TDF to TAF among CHB patients was associated with significant improvement in BMD and some markers of proximal renal tubular function. There was no improvement in urinary phosphate handling after the switch which suggests TDF has a direct effect on bone metabo lism that is reversible. Longer term and larger studies are need ed to confirm these findings.
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