Editor's note: Antiviral therapy is the most important treatment strategy for chronic hepatitis B (CHB), which reduces the occurrence of end-stage liver disease by inhibiting HBV replication, reducing hepatocellular inflammation and fibrous tissue proliferation. In addition to entecavir (ETV), tenofovir disoproxil (TDF) and tenofovir alafenol (TAF), the mainland Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2022 Edition) also recommend emitenofovir (TMF). TMF is a new type of nucleoside reverse transcriptase inhibitor independently developed in China, and its emergence is not only the progress of domestic HBV antiviral drugs, but also provides a new option for CHB patients.
On March 27~31, 2024, the 33rd Annual Meeting of the Asia-Pacific Association for the Study of the Liver (APASL 2024) was held in Kyoto, Japan.
▲Professor Chen Enqiang made a report on behalf of the team
Research 1
Patients with hypoviremia treated with ETV or TAF can be switched to rescue therapy with TMF
Background:
Some patients receiving ETV or TAF monotherapy may develop hypoviremia. This study aims to see if switching to emistenofovir monotherapy (TMF) can further improve the efficacy of antiviral therapy in these patients with chronic hepatitis B with hypoviremia.
Research Methods:
This is a retrospective study of patients with chronic hepatitis B who have received ETV or TAF monotherapy for more than 1 year, but serum HBV DNA consistently fluctuates between 20 and 2000 IU/mL. All enrolled patients voluntarily switched to TMF to continue antiviral therapy and completed a comprehensive examination at least every 6 months. The primary outcome measure was the undetectable rate of HBV DNA after 6 and 12 months of TMF treatment, and the secondary outcome measures were the incidence of tubular injury and dyslipidemia.
Findings:
A total of 73 patients were enrolled, of whom 47 received ETV and 26 received TAF. Among them, 33 cases were HBeAg positive and 40 cases were HBeAg negative. After 6 and 12 months of switching to TMF therapy, 69.9% (51/73) and 74.0% (54/73) of patients had HBV DNA < 20 IU/mL. Compared with HBeAg-positive patients, HBeAg-negative patients who switched to TMF had a higher proportion of complete virologic responses (19/33 vs. 32/40, P=0.038; 18/33 vs. 36/40, P<0.001）。 After 12 months of treatment, the rate of urinary 2-microglobulin abnormalities was 16.4% (12/73), and the proportion of urinary 2-globulin increased by three times the upper limit of normal was 6.8%. The proportion of blood phosphate below the lower limit of normal was 19.2% (14/73). Although total and LDL cholesterol levels were elevated compared with pre-treatment, the difference was not statistically significant.
Conclusions of the study
Switching to TMF can help most patients achieve a complete virologic response rate and be well tolerated by patients with chronic hepatitis B treated with ETV or TAF who develop hypoviremia.
原文链接：En-Qiang Chen, Lan-Qing Li, Jing Zhou, Yu-Jing Li, Cheng-Run Song, Min He, Yong-Hong Wang, Xue-Zhong Lei, Wei Jiang. Switching to TMF is effective for ETV or TAF monotherapy in patients with hypoviremia. APASL 2024 Abstract O-0142.
Research 2
Effect of TMF on blood lipid metabolism in patients with chronic hepatitis B
Background:
The potential effect of nucleos(t)ide analogue antiviral therapy on dyslipidemia in CHB patients and its clinical significance have attracted much attention in recent years. Due to the relatively short time on the market, the effect of emitenofovir (TMF) on blood lipids in CHB patients needs to be studied.
Research Methods:
Patients with chronic hepatitis B who have been treated with TMF monotherapy for more than 1 year were taken as the research objects, and the blood lipid metabolism related indexes before and after TMF treatment were quantitatively detected. Lipid markers include total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), very low-density lipoprotein (VLDL), and apolipoprotein B (ApoB).
Findings:
A total of 109 patients with complete demographic and clinical follow-up data were included who had peripheral blood TC, TG, HDL, VLDL, and ApoB levels within normal limits prior to TMF treatment. After more than 1 year of TMF treatment, 28.4% (31/109) of the patients had TG levels above the upper limit of normal (ULN), of which 67.7% (21/31) had an increase in ULN of no more than 30%, 15.6% (17/109) of patients had TC levels exceeding ULN, of which 52.% (9/17) had an increase of no more than 30% in 52.% (9/17) of patients, and 11% (12/109) of patients had VLDL levels exceeding ULN, of which 66.6% (8/ 12) patients with an increase in ULN of no more than 30%. In this group of cases, 14.7% (16/109) of patients had HDL levels above ULN. There was no significant difference in the average level of serum ApoB between patients before and after TMF treatment, but approximately 11% (12/109) of patients had a slightly higher peripheral blood ApoB than ULN after 1 year of TMF treatment.
Conclusions of the study
Some mild abnormalities in lipid profiles may occur in patients treated with TMF, but their clinical significance is unclear. Due to the small sample size of this study, the relevant conclusions need to be verified by clinical studies with large samples.
原文链接：En-Qiang Chen, Lan-Qing Li, Cheng-Run Song, Yu-Jing Li, Xue-Zhong Lei, Hong Tang, Dong-Mei Zhang, Yong-Hong Wang, Tao-You Zhou. The effect of tenofovir amibufenamide on lipid metabolism. APASL 2024 Abstract O-0177.
Previous Review
▶ Prof. Enqiang Chen's team: Liver fibrosis and health-related quality of life in patients with persistently normal ALT HBeAg-negative patients丨APASL 2024
▶ Prof. Chen Enqiang's team: The incidence of tubular absorption impairment in the treatment of chronic hepatitis B with NUC combined with Peg-IFNα is high, and it needs to be paid attention to in clinical practice丨APASL 2024
Source: Editorial Board of International Liver Disease