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    Home > Active Ingredient News > Digestive System Information > TAF can improve liver reserve and glomerular filtration rate in patients with hepatitis B cirrhosis after TIPS treatment

    TAF can improve liver reserve and glomerular filtration rate in patients with hepatitis B cirrhosis after TIPS treatment

    • Last Update: 2021-10-21
    • Source: Internet
    • Author: User
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    It is only for medical professionals to read for reference.
    Early initiation of antiviral therapy can benefit patients with hepatitis B and cirrhosis in the long-term treatment
    .

    Chronic hepatitis B (CHB) is one of the leading causes of hepatocellular carcinoma (HCC), complications of liver cirrhosis, and liver-related deaths worldwide [1]
    .

    Among patients with liver cirrhosis in China, 77% are caused by hepatitis B virus (HBV) [2].
    If not controlled in time, there may be bleeding from esophageal and gastric varices, hepatic encephalopathy (HE), intractable Severe complications such as pleural and ascites may even progress to liver failure and death due to HCC
    .

     Transjugular intrahepatic portosystemic shunt (TIPS) is an effective method for the treatment of complications of cirrhosis and portal hypertension, and it is currently the only minimally invasive treatment for relieving portal hypertension
    .

    Preliminary clinical studies have found that 24 months after TIPS treatment, the improvement of liver reserve in patients with hepatitis B cirrhosis is better than that of patients with alcoholic cirrhosis and primary biliary cirrhosis, which may be related to receiving etiological treatment (antiviral) [3]
    .

    At present, there is no report on the clinical efficacy of different first-line antiviral drugs in patients with hepatitis B liver cirrhosis after receiving TIPS treatment to relieve portal hypertension
    .

     Recently, the TIPS team of the Gastroenterology Department of the General Hospital of the Western Theater Command of the Chinese People's Liberation Army published a study in the World Journal of Gastroenterology to discuss the above issues
    .

    This study evaluated the clinical efficacy of three first-line antiviral treatments recommended by the "Chinese Guidelines for Chronic Hepatitis B Prevention and Treatment (2019 Edition)" [4] in patients with hepatitis B cirrhosis after TIPS
    .

    The study found that, 24 months after TIPS, compared with entecavir (ETV) and tenofovir disoproxil fumarate (TDF), tenofovir fumarate (TAF) improved liver reserve function and estimated renal small Sphere filtration rate (eGFR) has significant advantages [5]
    .

     The screenshot study on the homepage of the paper included 137 adult patients with hepatitis B cirrhosis and portal hypertension who were treated with TIPS from March 2016 to December 2020.
    According to the antiviral drugs used, they were divided into ETV group (n = 70) and TAF group ( n = 32) and TDF group (n = 35)
    .

    During the follow-up, the researchers collected the patients' serum HBV DNA levels, liver and kidney function, and blood coagulation data before and at 1, 3, 6, 12, and 24 months after the operation, and learned about ascites and liver through ultrasound examination and follow-up records.
    Encephalopathy, the cumulative incidence of HE and HCC, survival rate, liver reserve function and eGFR changes were evaluated.
    Liver reserve function was expressed by Child-Pugh classification and end-stage liver disease model score (MELD)
    .

     Survival rate, the cumulative incidence of HE and HCC.
    The median follow-up was 24 (20, 24) months.
    The survival rates at 12 and 24 months were TAF (93.
    3%, 89.
    6%) vs TDF (93.
    9%, 86.
    9%) vs ETV, respectively.
    (91.
    2%, 84.
    3%) (Log Rank X2=0.
    517, P=0.
    772) (Figure 1A)
    .

    The incidence of HE at 12 and 24 months after surgery was divided into TAF (15.
    6%, 19.
    5%) vs TDF (17.
    6%, 25.
    7%) vs ETV (20.
    9%, 28.
    3%) (Log Rank X2=0.
    712, P=0.
    700) (Figure 1B)
    .

    The incidence of HCC at 12 and 24 months after surgery was TAF (3.
    4%, 7.
    3%) vs TDF (3.
    6%, 7.
    3%) vs ETV (6.
    1%, 11.
    3%) (Log Rank X2=0.
    77, P=0.
    681) (Figure 1C)
    .

    There were no statistically significant differences in the survival rate, the incidence of HE and the incidence of HCC among the three groups of patients
    .

     Figure 1 The survival rate, the occurrence of HE and HCC of the three groups of patients, Child-Pugh score and MELD score changes, there was no significant difference in Child-Pugh scores between the three groups before and 12 months after surgery (P>0.
    05), and TAF Child at 24 months after surgery -Pugh score is 6.
    97±0.
    86, which is lower than TDF 7.
    49±0.
    82 (t=-2.
    52, P=0.
    014) and ETV 7.
    64±1.
    17 (t=-2.
    92, P=0.
    004) (see Figure 2)
    .

     Figure 2 Changes in Child-Pugh scores of the three groups of patients before and after TIPS There was no significant difference in the MELD scores of the three groups before and after 12 months (P>0.
    05); the MELD score of the TAF group was 9.
    72±1.
    5 at 24 months after the operation, compared with the TDF group 10.
    74±2.
    33 (t=-2.
    09, P=0.
    040) and 10.
    97±2.
    17 in the ETV group were low (t=-2.
    93, P=0.
    004) (see Figure 3)
    .

     Figure 3 The changes in MELD scores of the three groups of patients before and after TIPS.
    The results of the study showed that there was no significant difference in the changes of eGFR in the three groups after 3 months (P>0.
    05); 1.
    The eGFR (99.
    72±11.
    52) of the TAF group was high at 6 months after the operation.
    In the ETV group (91.
    24±12.
    60) (t=3.
    24, P=0.
    002), but there was no significant difference from the TDF group (94.
    97±12.
    52) (t=1.
    61, P=0.
    112); 2.
    The eGFR ( 103.
    44±13.
    02) was higher than the TDF group (94.
    11±12.
    34) (t=3.
    08, P=0.
    004) and the ETV group (90.
    03±11.
    04) (t=5.
    37, P<0.
    001); 3.
    The eGFR of the TAF group was 24 months after the operation ( 104.
    41±12.
    54) was higher than TDF group (93.
    54±8.
    97) and ETV group (89.
    96±9.
    86) (F=21.
    57, P<0.
    001) (see Figure 4)
    .

     Figure 4 Changes in the eGFR scores of the three groups of patients before and after TIPS.
    In summary, this retrospective study showed that patients with hepatitis B cirrhosis who received antiviral therapy after TIPS had significant improvements in liver reserve and eGFR compared to TDF and ETV.
    Advantages, it is still necessary to continue to observe the difference in the impact of long-term HCC occurrence
    .

    The surgical operation and clinical management of this study were all completed by the same group of doctors
    .

    The research team believes that improving the long-term survival rate of hepatitis B cirrhosis after TIPS is complicated and is determined by a large number of non-hemodynamic factors, such as age, degree of renal failure, chronic inflammation, urease-producing intestinal bacteria, bacterial translocation, and Malnutrition/atrophy is a very important factor in regulating treatment.
    Early initiation of antiviral therapy and optimization of antiviral treatment are also important factors.
    Choosing TAF, a drug that has less impact on kidney function and has a strong antiviral effect, may make patients in the long-term Benefit from treatment
    .

    Author's brief review: CHB patients with mild renal impairment can also benefit from TAF treatment|The latest research express reference: [1] Papatheodoridis GV, Chan HL, Hansen BE, et al.
    Risk of hepatocellular carcinoma in chronic hepatitis B: assessment and modification with current antiviral therapy.
    J Hepatol.
    2015 Apr;62(4):956-67.
    [2] Chinese Medical Association, Chinese Medical Association Journal, Chinese Medical Association General Medicine Branch, etc.
    Chronic Hepatitis B primary diagnosis and treatment guidelines (2020)[J].
    Chinese Journal of General Practitioners, 2021, 20(2): 137-149.
    [3] Yao X, Zhou H, Huang S, et al.
    Effects of transjugular intrahepatic portosystemic shunt using the Viatorr stent on hepatic reserve function in patients with cirrhosis[J].
    World Journal of Clinical Cases, 2021, 9(7): 1532.
    [4]Wang Guiqiang, Duan Zhongping.
    Guidelines for Prevention and Treatment of Chronic Hepatitis B (2019 Edition) [J].
    Liver, 2019, 24(12): 1335-1356.
    [5]Yao X, Huang S, Zhou H, et al.
    Clinical efficacy of antiviral therapy in patients with hepatitis B-related cirrhosis after transjugular intrahepatic portosystemic shunt [J].
    World Journal of Gastroenterology, 2021, 27(30): 5088.
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    .

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    .

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