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Long-term efficacy and safety of nucleos(t)ides analogues in patients with chronic hepatitis B

Nucleos(t)ide analogues with high barrier to resistance are regarded as the principal therapeutic option for chronic hepatitis B (CHB). Treatment with entecavir (ETV), tenofovir disoproxil (TDF) and the later released tenofovir alafenamide (TAF) is highly effective at controlling hepatitis B virus (...

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Autores principales: Roade, Luisa, Riveiro-Barciela, Mar, Esteban, Rafael, Buti, Maria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871062/
https://www.ncbi.nlm.nih.gov/pubmed/33614029
http://dx.doi.org/10.1177/2049936120985954
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author Roade, Luisa
Riveiro-Barciela, Mar
Esteban, Rafael
Buti, Maria
author_facet Roade, Luisa
Riveiro-Barciela, Mar
Esteban, Rafael
Buti, Maria
author_sort Roade, Luisa
collection PubMed
description Nucleos(t)ide analogues with high barrier to resistance are regarded as the principal therapeutic option for chronic hepatitis B (CHB). Treatment with entecavir (ETV), tenofovir disoproxil (TDF) and the later released tenofovir alafenamide (TAF) is highly effective at controlling hepatitis B virus (HBV) infection and, in the vast majority of patients, is well tolerated. No significant differences in viral suppression have been described among the different regimens, although an earlier achievement in biochemical response has been suggested first under TDF and recently under TAF. High barrier to resistance NAs rarely achieve hepatitis B surface antigen sero-clearance, and therefore should be maintained life-long in most cases. This has increased concerns about treatment-related toxicity, especially in patients under TDF with additional risk factors for kidney and bone impairment. TAF has shown a better bone and kidney safety profile than TDF, although it is not yet available worldwide due to its higher cost. Emergence of adverse events should be monitored since treatment-switch to ETV/TAF seems to be effective and safe in HBV mono-infected subjects. Finally, although an effective antiviral treatment leads to a clear improvement in clinical outcome of CHB patients; the risk of developing hepatocellular carcinoma (HCC) is not completely avoided with viral suppression. Whether tenofovir-based regimens provide any additional benefit over ETV in HCC prevention remains unclear and requires further investigation.
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spelling pubmed-78710622021-02-19 Long-term efficacy and safety of nucleos(t)ides analogues in patients with chronic hepatitis B Roade, Luisa Riveiro-Barciela, Mar Esteban, Rafael Buti, Maria Ther Adv Infect Dis Review Nucleos(t)ide analogues with high barrier to resistance are regarded as the principal therapeutic option for chronic hepatitis B (CHB). Treatment with entecavir (ETV), tenofovir disoproxil (TDF) and the later released tenofovir alafenamide (TAF) is highly effective at controlling hepatitis B virus (HBV) infection and, in the vast majority of patients, is well tolerated. No significant differences in viral suppression have been described among the different regimens, although an earlier achievement in biochemical response has been suggested first under TDF and recently under TAF. High barrier to resistance NAs rarely achieve hepatitis B surface antigen sero-clearance, and therefore should be maintained life-long in most cases. This has increased concerns about treatment-related toxicity, especially in patients under TDF with additional risk factors for kidney and bone impairment. TAF has shown a better bone and kidney safety profile than TDF, although it is not yet available worldwide due to its higher cost. Emergence of adverse events should be monitored since treatment-switch to ETV/TAF seems to be effective and safe in HBV mono-infected subjects. Finally, although an effective antiviral treatment leads to a clear improvement in clinical outcome of CHB patients; the risk of developing hepatocellular carcinoma (HCC) is not completely avoided with viral suppression. Whether tenofovir-based regimens provide any additional benefit over ETV in HCC prevention remains unclear and requires further investigation. SAGE Publications 2021-02-05 /pmc/articles/PMC7871062/ /pubmed/33614029 http://dx.doi.org/10.1177/2049936120985954 Text en © The Author(s), 2021 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Review
Roade, Luisa
Riveiro-Barciela, Mar
Esteban, Rafael
Buti, Maria
Long-term efficacy and safety of nucleos(t)ides analogues in patients with chronic hepatitis B
title Long-term efficacy and safety of nucleos(t)ides analogues in patients with chronic hepatitis B
title_full Long-term efficacy and safety of nucleos(t)ides analogues in patients with chronic hepatitis B
title_fullStr Long-term efficacy and safety of nucleos(t)ides analogues in patients with chronic hepatitis B
title_full_unstemmed Long-term efficacy and safety of nucleos(t)ides analogues in patients with chronic hepatitis B
title_short Long-term efficacy and safety of nucleos(t)ides analogues in patients with chronic hepatitis B
title_sort long-term efficacy and safety of nucleos(t)ides analogues in patients with chronic hepatitis b
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871062/
https://www.ncbi.nlm.nih.gov/pubmed/33614029
http://dx.doi.org/10.1177/2049936120985954
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