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Higher risk of kidney function decline with entecavir than tenofovir alafenamide in patients with chronic hepatitis B

 Chan-Young Jung  ;  Hyung Woo Kim  ;  Sang Hoon Ahn  ;  Seung Up Kim  ;  Beom Seok Kim 
 LIVER INTERNATIONAL, Vol.42(5) : 1017-1026, 2022-05 
Journal Title
Issue Date
Alanine* / adverse effects ; Antiviral Agents / adverse effects ; Guanine* / adverse effects ; Guanine* / analogs & derivatives ; Hepatitis B, Chronic* / drug therapy ; Humans ; Kidney Diseases* / epidemiology ; Risk Assessment ; Tenofovir* / adverse effects ; Tenofovir* / analogs & derivatives ; Treatment Outcome
entecavir ; hepatitis B virus ; kidney function ; tenofovir alafenamide
Background and aims: Entecavir (ETV) and tenofovir alafenamide (TAF) are the preferred agents in patients with predisposing factors for nephrotoxicity, but no studies to date have directly compared the renal safety of the two antiviral agents. Hence, we compared the risk of kidney function decline among patients with treatment-naïve chronic hepatitis B (CHB) treated with ETV or TAF.

Methods: This study included 1988 patients with treatment-naïve CHB who were treated with ETV (n = 1839) or TAF (n = 149) between 2007 and 2020 for ETV and between 2017 and 2020 for TAF. The primary outcome was chronic kidney disease (CKD) progression, defined as an increase in CKD stage by at least one stage for at least three consecutive months.

Results: A 1:1 propensity score match yielded 149 patients in each treatment group. The mean estimated glomerular filtration rate (eGFR) was 100.6 ml/min/1.73 m2 vs. 101.3 ml/min/1.73 m2 in the ETV and TAF groups respectively. A total of 61 patients developed a progression in CKD stage ≥ 1, of which 47 and 14 patients were from the ETV- and TAF-treated groups respectively (19.9 vs. 5.1 per 1000 person-years; p < .001). The risk of progression in CKD stage ≥1 was significantly higher in patients treated with ETV, even when adjusted for potential confounders (adjusted hazard ratio 4.05; 95% CI 2.14-7.68; p < .001).

Conclusions: ETV was associated with a higher risk of kidney function decline than TAF in patients with treatment-naïve CHB. Therefore, further prospective randomized studies are needed.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Beom Seok(김범석) ORCID logo https://orcid.org/0000-0002-5732-2583
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Kim, Hyung Woo(김형우) ORCID logo https://orcid.org/0000-0002-6305-452X
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Jung, Chan-Young(정찬영) ORCID logo https://orcid.org/0000-0002-2893-9576
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