Tenofovir AlafenamideとEntecavirを併用した慢性B型肝炎患者の推定グルメルフィルタレーション率の経度変化
Xuan Li1,2, Qiang Wu3, Fang Huang4
1Department of Liver Diseases, Shenzhen Third People's Hospital, Shenzhen, Guangdong, China.
PeerJ
|September 2, 2025
まとめ
テノフォビルアラフェナミド (TAF) とエンテカビル (ETV) は,慢性B型肝炎 (CHB) の治療に推奨されています. この研究では,TAFは腎臓の安全性においてETVに匹敵し,TAFは男性および高齢の患者で有益であることが示された.
科学分野:
- ヘパトロジー
- 腎臓科
- 薬理学について
背景:
- 慢性B型肝炎 (CHB) の治療には,様々な腎臓毒性リスクを持つ抗ウイルス療法が含まれます.
- 腎臓損傷のリスクが高いCHB患者には,エンテカビル (ETV) とテノフォビルアラフェナミド (TAF) が推奨されます.
- 治療前のCHB患者におけるTAFとETVの比較性腎臓安全性の調査は極めて重要です.
研究 の 目的:
- 慢性B型肝炎 (CHB) の治療先の患者でテノフォビルアラフェナミド (TAF) とエンテカビル (ETV) の腎臓安全性プロフィールを比較する.
- 2つの抗ウイルス治療の間に慢性腎疾患 (CKD) の発生率と推定球膜濾過率 (eGFR) の変化を分析する.
- 腎臓の健康に関してTAFまたはETVからより恩恵を受ける患者のサブグループを特定する.
主な方法:
- 2019年7月から2020年12月の間にTAFまたはETVを投与された466人の治療前のCHB患者を含むコホート研究.
- 推定グルメルフィルタレーション率 (eGFR) をモニタリングし,コックス回帰分析により,CKD発症に関連する要因が特定されました.
- 汎用添加混合モデル (GAMM) は,一時的なeGFR変化と抗ウイルス剤の影響を評価した.
主要な成果:
- 発症率はTAF群とETV群 (9. 8%対13. 9%,p=0. 304) で,基値eGFR>90ml/ min/ 1. 73m2であった.
- 男性の性別と基礎値より低いEGFRは,CKD発症の有意な予測因子でした.
- GAMMは,TAFは,ETVと比較して,特に男性および35歳以上の患者で,eGFRの減少率が著しく低いことを示した (調整された差:0. 38mL/ min/ 1. 73m2/ 12週間,p=0. 006).
結論:
- テノフォビルアラフェナミド (TAF) は,治療前のCHB患者でエンテカビル (ETV) と比較可能な腎臓安全性を示しています.
- 男性と35歳以上の患者を含む特定のサブグループにおいて,TAFはETVよりも腎臓に優れていることを示した.
- これらの発見は,腎臓の保護を最適化するために,CHB管理のための個別化された抗ウイルス選択を支持する.
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