Tenofovir alafenamide on par with entecavir in treatment-naive chronic hepatitis B

Biochemical response (BR) rates do not differ between entecavir (ETV) and tenofovir alafenamide (TAF), but virologic (VR) and complete response (CR) rates are modestly higher with TAF, reveals a study.

A total of 1,605 treatment-naïve chronic hepatitis B patients who initiated either ETV or TAF in 2016 or after across 22 international centres were included in this retrospective analysis. The research team assessed the participants’ treatment response after balancing their characteristics using inverse probability treatment weight and through Fine-Gray competing-risks analysis of the balanced cohort.

Of the patients, 784 received TAF and 821 ETV, and the majority (n=1,553, 96.8 percent) were from Asia. Inverse probability treatment-weighting analysis resulted in a total cohort of 1,660 (822 TAF and 838 ETC patients with balanced characteristics).

The cumulative VRs at 5 years were high in both treatment groups, with a slightly higher rate in the TAF cohort (98.0 percent vs 93.9 percent; p<0.001). Subgroup analysis by median hepatitis B virus (HBV) DNA (5.5 log IU/mL) revealed similar findings.

However, no significant between-group difference was observed in 5-year BR rates overall (93.7 percent vs 92.8 percent; p=0.484) or by alanine aminotransferase (ALT) cutoff of 2x upper limit of normal.

TAF-treated patients had a slightly higher 5-year cumulative CR overall (94.9 percent vs 89.4 percent; p=0.001), as did those with high HBV DNA (96.9 percent vs 87.9 percent; p<0.001) or ALT ≥2× upper limit of normal (97.3 percent vs 90.6 percent; p<0.001), but not those with lower HBV DNA or ALT.

“Antiviral selection between TAF vs ETV should be based mainly on cost, side effect profile, and patient preference,” the researchers said.