Real‐life impact of tenofovir disoproxil fumarate and entecavir therapy on lipid profile, glucose, and uric acid in chronic hepatitis B patients

The impact of long‐term nucleos(t)ide analogs treatment on host metabolism is a concern. Hence, we conducted this study to compare the effect of entecavir (ETV) and tenofovir disoproxil fumarate (TDF) on metabolic parameters among chronic hepatitis B (CHB) patients. In this real‐life retrospective study, 2030 CHB outpatients treated with ETV or TDF at Nanfang Hospital, China, were included. For treatment‐naïve patients, pretreatment and semiannual metabolic parameters were collected. For treatment‐experienced patients, metabolic parameters were collected at the first visit. Propensity score matching (PSM) was used to balance the effects of potential confounding factors. Among 122 treatment‐naïve patients and 1908 treatment‐experienced patients, ETV‐treated patients were older with a higher percentage of metabolic syndrome. After PSM, the characteristics were comparable between the two groups. For treatment‐naïve patients, four lipid parameters, including total cholesterol (TC), low‐density lipoprotein (LDL), high‐density lipoprotein, and triglyceride levels showed a decreasing trend during the 42‐month TDF treatment, while they remained relatively stable or increased during ETV treatment. At Month 30, the levels of TC and LDL among TDF‐treated patients were significantly lower than those among ETV‐treated patients (TC: 4.7 mmol/L vs. 3.9 mmol/L, p = 0.004; LDL: 3.0 mmol/L vs. 2.4 mmol/L, p = 0.009). For treatment‐experienced patients, we also observed lower levels of lipid parameters in patients with different durations of TDF treatment. The levels of glucose and uric acid were similar among ETV‐ and TDF‐treated patients. TDF has a lipid‐lowering effect in CHB patients, which provides a basis for the selection of antiviral drugs for aging CHB patients.