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Expert Rev Gastroenterol Hepatol. 2017 Nov;11(11):999-1008. doi: 10.1080/17474124.2017.1386554. Epub 2017 Oct 8.

Tenofovir alafenamide as compared to tenofovir disoproxil fumarate in the management of chronic hepatitis B with recent trends in patient demographics.

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a School of Medicine and Big Data Research Centre, College of Medicine, Fu-Jen Catholic University , New Taipei , Taiwan.
b Division of Gastroenterology and Hepatology , Fu-Jen Catholic University Hospital , New Taipei , Taiwan.
c Division of Gastroenterology and Hepatology , E-Da Hospital , Kaohsiung , Taiwan.
d Department of Medicine , Stanford University Medical Center , Palo Alto , CA , USA.
e Division of Gastroenterology and Hepatology , Stanford University Medical Center , Palo Alto , CA , USA.


Tenofovir alafenamide (TAF) has recently been approved for chronic hepatitis B (CHB). It is more stable than tenofovir disoproxil fumarate (TDF) in the plasma and can provide similar efficacy with lower circulating concentration in patients with hepatitis B virus (HBV) infection. Areas covered: This synopsis will review the current anti-HBV standard practice and the changing epidemiology of CHB, specifically the controversies surrounding the renal and bone safety associated with TDF use in the context of an aging CHB population. We will review data from phase 3 registration trials, which demonstrated TAF was not inferior to TDF in antiviral efficacy for both HBeAg-positive and HBeAg-negative patients, while associated with less reduction in the estimated glomerular filtration rate and bone mineral density. Expert commentary: Current data supports the use of TAF as one of the first-line antiviral agents for general CHB patients without hepatic decompensation. However, more real-world data with long-term observation are needed to better define the role of TAF among other oral regimens. Additional studies are also needed to evaluate the efficacy and safety of TAF in special populations such as those with impaired hepatic function, existing impaired renal and/or bone function, and in pregnant women.


HBV; TAF; TDF; osteoporosis; renal insufficiency

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