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      • Safety and Efficacy at 1-Year after Switching from TDF to TAF in CHB Patients with Risk Factors for TDF Use

        ( Byoung Kuk Jang ),( Edward Gane ),( Wai Kay Seto ),( Harry La Janssen ),( Florin A Caruntu ),( Hyung Joon Kim ),( Dzhamal Abdurakhmanov ),( Shuhei Nishiguchi ),( Andrzej Horban ),( Ho Bae ),( John F 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

        Aims: Tenofovir alafenamide (TAF), a new prodrug of tenofovir (TFV), is now a preferred treatment in the 2017 EASL HBV Guidelines, and may be particularly useful in patients with risk factors for TDF associated renal and bone effects. We assessed the 1 year safety and efficacy in CHB patients with TDF risk factors who were switched from TDF to TAF. Methods: In two identically-designed Phase 3 studies, HBeAg(+) and HBeAg(-)patients were randomized 2:1 to TAF 25 mg or TDF 300 mg and treated in a double- blind fashion for 96 weeks; all patients received open-label (OL) TAF for an additional 48 weeks (through Week 144). Renal and bone safety parameters, and antiviral efficacy (HBV DNA < 29 IU/mL) and ALT normalization were assessed in the subset of switch patients with baseline risk factors for TDF use: Age >60 years, osteoporosis of hip or spine, ³Stage 2 CKD (GFRCG < 90 mL/ min), albuminurina (UACR >30 mg/g), hypophosphatemia (PO4 <2.5 mg/dL), or presence of comorbidities (e.g. HTN, DM). Results: Of 1298 patients randomized and treated in the 2 studies, 540(42%) switched to open- label TAF at Week 96 (TAF<sup>®</sup>TAF 360; TDF<sup>®</sup>TAF 180), of which 284(53%) patients had at least 1 TDF risk factor at baseline; 123(23%) patients had ³2 risk factors. Baseline demographics and disease characteristics were similar between treatment groups. At Week 144, significant improvements in renal (sCr, eGFRCG) parameters, hip and spine BMD were observed and summarized in the table. Antiviral efficacy was maintained at Week 144 in both groups and in TDF patients who switched to TAF, increased rates of ALT normalization were seen. Conclusions: In CHB patients with risk factors for potential TDF toxicity, switching from TDF to TAF resulted in improved bone and renal safety parameters while efficacy was maintained in this subgroup at one year.

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