Comparison of the side effects of antivirals in chronic hepatitis B patients: a single-center experience

Abstract

Background and study aim: Entecavir (ETV), Tenofovir Disoproxil Fumarate (TDF), and Tenofovir Alafenamide (TAF) have been approved for treating Chronic Hepatitis B (CHB) and recommended due to their high safety profile and high resistance barriers. This study aimed to evaluate the kidney functions, bone, and metabolic parameters in CHB patients receiving ETV, TDF, and TAF treatment. Patients and methods: In this retrospective cohort study, a total of 469 CHB patients who were treated with TDF (n = 256), ETV (n = 184), or TAF (n = 129) for at least six months between March 2012 and March 2022, were enrolled. Results: No significant difference was observed between three groups regarding ALT normalization, HBV DNA suppression, and HBs Ag seroconversion (p = 0.15, p = 0.26, p = 0.72). After the treatment, there was a significant decrease in GFR values in the TDF, ETV, and TAF groups (p<0.01, p = 0.01, p = 0.01, respectively). No significant improvement was observed in the GFR values after TAF treatment in 77 patients who had switched from TDF to TAF (p = 0.51). Moreover, no significant decrease in bone mineral densities was observed in the TDF, ETV, and TAF groups (p = 0.24, p = 0.41, p = 0.95, respectively). There was no significant difference between the three groups in metabolic parameters (serum glucose, lipid profile, calcium and phosphorus levels, etc.) when the data were adjusted for underlying comorbidities. Conclusions: ETV, TDF, and TAF are comparably safe and effective antiviral agents against CHB.

Renal and bone side effects of Entecavir, tenofovir disoproxil fumarate, tenofovir alafenamide fumarate in patients with hepatitis B: a network meta- analysis

“…Studies have shown that long-term use of antiviral drugs can lead to bone and kidney damage. [10][11][12][13][14][15] Many studies have shown that nucleoside analogues have renal toxicity, mainly because nucleoside analogues are affected by renal metabolism, mainly proximal renal tubules, which can lead to a decrease in eGFR. In addition, reduced phosphate reabsorption by proximal renal tubules causes bone disease, with the main outcome being hypopuricemia, hypophosphatemia leading to defects in bone mineralization, osteomalacia, and fractures.…”