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

Summary 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 s 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 s 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. These data, together with recommendations from various CHB treatment guidelines, support the concept of switching to TAF in individual patients with CHB, including those at risk of bone or renal complications, elderly patients and those with previous NA treatment.