Relapse higher in HBeAg- patients after cessation of TAF vs TDF, entecavir

Patients who discontinue tenofovir alafenamide (TAF) therapy appear to have a higher hepatitis B virus relapse rate than those who ceased entecavir or tenofovir disoproxil fumarate (TDF) therapy, according to a recent study.

This study included 805 hepatitis B e antigen-negative patients without cirrhosis, of which 406 received entecavir, 260 received TDF, and 139 received TAF. The authors applied the propensity score matching method to eliminate the significant differences in clinical characteristics.

At 96 weeks, the off-TAF group had higher cumulative incidences of virological relapse (89.6 percent vs 65.9 percent and 73.7 percent), clinical relapse (70.3 percent vs 42.8 percent and 49.8 percent), and retreatment (59.2 percent vs 28.8 percent and 35.7 percent) than the off-entecavir and off-TDF groups.

The median time to clinical relapse was much earlier in the off-TAF group than the off-entecavir or the off-TDF groups (median 14 vs 57 and 26 weeks). These findings were maintained even after propensity score matching.

In multivariate analysis, TAF therapy was independently associated with virological relapse, clinical relapse, and retreatment when compared with entecavir or TDF therapy.

Hepatitis B surface antigen levels at end of treatment predicted virological, but not clinical, relapse in the off-TAF group. However, patients who discontinued TAF therapy had a lower rate of severe hepatitis on clinical relapse than those who discontinued TDF therapy.

“Finally, there was no significant difference in the hepatic decompensation rate among the entecavir, TDF, and TAF groups,” the authors said.

“Close monitoring is necessary after TAF withdrawal, particularly in the first 3 months,” they added.