Review article: switching patients with chronic hepatitis B to tenofovir alafenamide-a review of current data

BACKGROUND

The nucleos(t)ide analogues (NAs) entecavir (ETV), tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) are preferred treatment options for patients with chronic hepatitis B infection (CHB). However, resistance to ETV has been reported, especially with prior exposure to other NAs, and long-term TDF treatment has been associated with decline in renal function and loss of bone mineral density in some patients. Consequently, TAF may be preferable to ETV, TDF or other NAs in specific circumstances such as in patients with risk of bone or renal complications, elderly patients or those with previous NA experience.

AIM

To provide a summary of the available efficacy and safety data following switch to TAF from other NAs in patients with CHB in clinical studies and real-world settings.

METHODS

Literature searches were performed on PubMed and abstracts from three major international liver congresses between 2019 and 2021. Studies that included efficacy and/or safety data for patients with CHB switching from any NA to TAF were selected.

RESULTS

Thirty-six papers and abstracts were included in this narrative review. Switching from TDF to TAF maintained or improved virological and biochemical responses with improved bone and renal safety. Switching from ETV or other NAs to TAF maintained or improved virological and biochemical responses and varying results for bone and renal safety.

CONCLUSIONS

Switching to TAF appears to maintain or improve virological, biochemical and bone- and renal-related safety outcomes. These data support the concept of switching to TAF in some patients with CHB based on their individual circumstances.

Modelling NAFLD disease burden in four Asian regions-2019-2030

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) account for an increasing proportion of liver disease in the Asia-Pacific region. Many areas in the region are experiencing epidemics of metabolic syndrome among rapidly ageing populations.

AIMS

To estimate using modelling the growth in NAFLD populations, including cases with significant fibrosis that are most likely to experience advanced liver disease and related mortality.

METHODS

A disease progression model was used to summarise and project fibrosis progression among the NAFLD populations of Hong Kong, Singapore, South Korea and Taiwan. For each area, changes in the adult prevalence of obesity was used to extrapolate long-term trends in NAFLD incidence.

RESULTS

In the areas studied, prevalent NAFLD cases were projected to increase 6%-20% during 2019-2030, while prevalent NASH cases increase 20%-35%. Incident cases of hepatocellular carcinoma are projected to increase by 65%-85%, while incident decompensated cirrhosis cases increase 65%-100% by 2030. Likewise, NAFLD-related mortality is projected to increase between 65% and 100% from 2019 to 2030. NAFLD disease burden is expected to increase alongside rising trends in metabolic syndrome and obesity among populations in the region. This leads to more cases of advanced liver disease and associated mortality.

CONCLUSIONS

Preventing the growth of diabetic and obese populations will be a key factor in reducing ongoing increases in NAFLD-related disease burden in the Asia-Pacific region.

Propafenone disposition during continuous venovenous hemofiltration

OBJECTIVE

To determine the extent of removal of propafenone by continuous venovenous hemofiltration (CVVH) in a critically ill pediatric patient.

CASE SUMMARY

A three-year-old white-Japanese girl was admitted to the critical care unit following cardiac surgery. Her postoperative course was complicated by the development of junctional ectopic tachycardia, requiring propafenone, and acute renal failure, which necessitated the use of CVVH. The serum and ultrafiltrate concentrations of propafenone and its 5-hydroxy metabolite were measured to determine both total and CVVH clearance.

CONCLUSIONS

The data from this case report showed that propafenone was not significantly removed by CVVH. Furthermore, the total clearance of propafenone was not affected by the patient's renal or liver function impairment.

Asthma knowledge and management in primary schools in south Auckland

AIMS

to examine the management of asthma in primary schools and the school teachers' knowledge, confidence and attitude in managing the pupils with asthma.

METHODS

forty-two primary schools in south Auckland were randomly selected to participate. Questionnaires were posted out to the principals and another questionnaire was given randomly to 253 teachers from these primary schools.

RESULTS

76% of the school principals surveyed returned the questionnaire; and 66% of the school teachers surveyed returned a separate questionnaire. The average incidence of asthma reported by school principals and school teachers was 9.9% and 12.6% respectively, which suggests underreporting of the diagnosis of asthma. In 81% of the schools a questionnaire was used to identify students with asthma when they first join the school. School teachers had good basic knowledge on asthma, however 33% of teachers did not know that Ventolin (salbutamol) is for symptomatic treatment and 58% and 65% of teachers did not know that Becotide (beclomethasone) and Intal (sodium cromoglycate) are prophylactic medications.

CONCLUSIONS

we suggest that primary school teachers should receive further education on asthma, especially on practical aspects of asthma management.