HBV: ETV an effective rescue therapy for TDF nephrotoxicity

  • Liver Int
  • 7 Dec 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Entecavir (ETV, Baraclude) is a safe and effective HBV rescue strategy for patients who develop tenofovir disoproxil fumarate (TDF; Viread)-related renal dysfunction.

Why this matters

  • TDF nephrotoxicity can also be counteracted by switching to tenofovir alafenamide (Vemlidy), but ETV generics are widely available.

Study design

  • Multicenter Italian study of 103 patients (median age, 64 years; 83% male) with TDF-associated glomerular and/or tubular dysfunction.
  • Modification of Diet in Renal Disease (MDRD) formula used to estimate glomerular filtration rate (eGFR, in mL/minute/1.73 m2).
  • Funding: Italian Ministry of Health.    

Key results

  • 98% had undetectable viral load; 49% were cirrhotic.
  • 47% were lamivudine-resistant (LMV-R), 71% were adefovir (ADV)-experienced.
  • Patients switched to TDF for eGFRMDRD
  • At a median of 46 months, TDF yielded improvements in median:
    • Creatinine levels (1.30-1.10 mg/dL; P<.0001>
    • eGFRMDRD (54-65; P=.002).
    • Blood phosphate levels (2.2-2.6 mg/dL; P<.0001>
    • Maximal tubule phosphate reabsorption (0.47-0.62 mmol/L; P<.0001>
  • 52% of patients achieved eGFRMDRD >60, 35% had normalized blood phosphate levels, and 22% experienced both.
  • 95% of patients maintained viral suppression; all breakthroughs occurred with LMV-R.
  • 5-year cumulative probability of ETV resistance:
    • LMV-R, 11%.
    • LMV-experienced, 7%.
    • LMV-naive, 0%.

Limitations

  • Open-label, retrospective, single-arm design.