6533b85ffe1ef96bd12c2684
RESEARCH PRODUCT
Effectiveness and safety of switching to entecavir hepatitis B patients developing kidney dysfunction during tenofovir
Erica VillaPietro LamperticoGloria TalianiAldo MarroneFabrizio BronteMaurizio RusselloG. GrossiPietro AndreoneMassimo FasanoSara LabancaMauro ViganòGiuseppina BrancaccioVincenzo OcchipintiAlessandra TucciFloriana FacchettiVincenzo MessinaRoberto GangaAlessandro LoglioStefano FagiuoliTeresa SantantonioNicola CoppolaAlfredo MarzanoMaria Grazia RumiSerena ZaltronFrancesco Castellisubject
MaleTime FactorsSustained Virologic Responsehepatitis B viruKidneyGastroenterologyhepatitis B virus; liver; liver function tests; renal dysfunction; viral hepatitischemistry.chemical_compound0302 clinical medicine80 and overAdefovirChronicAged 80 and overKidneymedicine.diagnostic_testDrug Substitutionhepatitis B virus; liver; liver function tests; renal dysfunction; viral hepatitis; HepatologyEntecavirMiddle AgedHepatitis BHepatitis BTreatment Outcomemedicine.anatomical_structureItaly030220 oncology & carcinogenesisFemaleKidney Diseases030211 gastroenterology & hepatologyViral hepatitismedicine.drugAdultmedicine.medical_specialtyGuaninehepatitis B virus; liver; liver function tests; renal dysfunction; viral hepatitis; Adult; Aged; Aged 80 and over; Antiviral Agents; Female; Guanine; Hepatitis B Chronic; Humans; Italy; Kidney; Kidney Diseases; Male; Middle Aged; Recovery of Function; Retrospective Studies; Sustained Virologic Response; Tenofovir; Time Factors; Treatment Outcome; Drug Substitutionviral hepatitisRenal functionliverAntiviral Agents03 medical and health sciencesHepatitis B ChronicInternal medicinerenal dysfunctionmedicineHumansliver function testTenofovirAgedRetrospective StudiesCreatinineHepatologybusiness.industryviral hepatitiRecovery of Functionmedicine.diseasechemistryliver function testsbusinessLiver function testshepatitis B virusdescription
Background and Aims: Tenofovir disoproxil fumarate (TDF) is recommended for chronic hepatitis B (CHB) treatment, but it may induce kidney dysfunction whose management is not yet known. This Italian, multicentre, retrospective study aimed to assess the efficacy and safety of switching to entecavir (ETV) patients who developed TDF-associated glomerular and/or tubular dysfunction. Methods: A total of 103 TDF-treated patients were included as follows: age 64 years, 83% male, 49% cirrhotics, 98% with undetectable HBV DNA, 47% with previous lamivudine resistance (LMV-R) and 71% previously treated with adefovir. Twenty-nine (28%) were switched to ETV because estimated glomerular filtration rate (eGFR MDRD ) was <60 mL/min, 37 (36%) because blood phosphate (P) levels were <2.5 mg/dL and 37 (36%) for both reasons. Kidney, liver and virological parameters were recorded every 4 months thereafter. Results: During 46 (4-115) months of ETV treatment, all patients’ renal parameters significantly improved as follows: creatinine from 1.30 to 1.10 mg/dL (P < 0.0001), eGFR MDRD from 54 to 65 mL/min (P = 0.002), P from 2.2 to 2.6 mg/dL (P < 0.0001) and maximal tubule phosphate reabsorption (TmPO4/eGFR) from 0.47 to 0.62 mmol/L (P < 0.0001). Thirteen patients (52%) improved their eGFR MDRD class, P levels were normalised in 13 (35%), and eight (22%) showed improvements in both parameters. Viral suppression was maintained in all but five patients (5%), all of whom had been LMV-R. The 5-year cumulative probability of ETV-R was 0% in LMV-naïve patients, and 11% in LMV-R patients (P = 0.018). Conclusions: Entecavir is an effective and safe rescue strategy for CHB patients who develop renal dysfunction during long-term TDF treatment.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2019-01-07 |