TAF is a new prodrug of tenofovir, specifically designed to achieve higher intracellular active drug concentration allowing for dosing of only 25 mg once daily and thus can potentially lower the already relatively low risk of renal toxicity and bone loss with TDF. However, such renal and bone complications with TDF may become more pronounced in decompensated CHB patients10. In the phase 3 trials11, 12, TAF had demonstrated a compatible antiviral effect (noninferior efficacy), and a higher rate of alanine aminotransferase (ALT) normalization to TDF. TAF also demonstrated an improved renal function and less bone loss compared to TDF. Therefore, TAF was approved as the first line therapy for CHB patients with compensated liver function. The lack of data regarding TAF therapy in decompensated CHB patients raised the concern of safety and efficacy of TAF in this group of patients. A small, single arm Phase 2 switch study (GS-US-320-4035; Study 4035; NCT03180619) which has enrolled 31 subjects with CPT scores ≥7, either at time of screening or by history, who were virally suppressed on TDF and/or other oral antiviral agents is currently underway with favorable safety and efficacy results through 48 weeks.\[Lim YS, Lin CY, Heo J, et al. EASL 2020, poster SAT442.\] While Gilead Study 4035 will continue through 96 weeks of treatment, additional data in this population are thus needed, particularly in CHB patients who have decompensated liver disease and are not being treated and are viremic. Herein, we conduct the present study and aim to investigate the safety and efficacy of TAF in CHB patients with hepatic decompensation.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
100
Approximately 100 adults, cirrhotic or non-cirrhotic (capped at 50), CHB patients with hepatic decompensation, will receive initial treatment (Arm A) with or switch (Arm B) to TAF 25 mg/day for 144 weeks. For Initiation Arm (Arm A), CHB patients with hepatic decompensation, who are currently not under HBV antiviral treatment will be enrolled. For Switch Arm (Arm B), CHB patients who are currently with hepatic decompensation and virally suppressed under HBV NUC treatment (HBV DNA \< 20 IU/mL) will be enrolled.
Kaohsiung Medical University Hospital
Kaohsiung City, Taiwan
RECRUITINGComplete virological suppression
Proportion of patients treated with TAF who achieve complete virological suppression (HBV DNA \< 20 IU/ml) at week 48 of TAF therapy in per-protocol (PP) population.
Time frame: week 48
Rate of adverse events
Rate of adverse events including serious adverse events and discontinuation at Week 48
Time frame: week 48
Rate of recovery from hepatic decompensation
Rate of recovery from hepatic decompensation (improvement of CTP score ≥1) at week 48, 96, and 144 of TAF therapy in FAS, modified FAS (mFAS) and PP populations.
Time frame: week 48, 96, and 144
Liver transplant-free survival
Liver transplant-free survival at week 48, 96, and 144 of TAF therapy in FAS, mFAS and PP populations.
Time frame: week 48, 96, and 144
Rate of virological response
Rate of virological response (HBV DNA \< 20 IU/ml) at week 96, and 144 of TAF therapy
Time frame: week 96, and 144
Rate of ALT normalization
Rate of ALT normalization by local (\<40 U/L), and AASLD (male ≤35, female ≤25 U/L) criteria at week 48, 96, and 144 of TAF therapy in FAS, mFAS and PP populations.
Time frame: week 48, 96, and 144
Rate of HBeAg loss/seroconversion, HBsAg loss/seroconversion
Rate of HBeAg loss/seroconversion in baseline HBeAg-seropositive patients, HBsAg loss/seroconversion, and change in HBsAg titer at week 48, 96, and 144 of TAF therapy.
Time frame: week 48, 96, and 144
Changes of serum creatinine
Changes of serum creatinine from baseline to week 48, 96, and 144 of TAF in mFAS and PP populations.
Time frame: week 48, 96, and 144
Changes of calculated creatinine clearance
Changes of calculated creatinine clearance (Cockcroft-Gault) from baseline to week 48, 96, and 144 of TAF in mFAS and PP populations.
Time frame: week 48, 96, and 144
Changes in bone mineral density
Changes in bone mineral density from baseline to week 144 of TAF in mFAS and PP populations.
Time frame: week 144
Changes in value of transient elastography
Changes in value of transient elastography (Fibroscan, kPa) from baseline to week 144 in mFAS and PP populations.
Time frame: week 144
Changes in body mass index
Changes in body mass index (BMI) from baseline to week 48, 96, and 144 of TAF in mFAS and PP populations.
Time frame: week 48, 96, and 144
Changes in blood lipid profile
Changes in fasting blood lipid profiles from baseline to week 48, 96, and 144 of TAF in mFAS and PP populations.
Time frame: week 48, 96, and 144
Changes in blood glucose
Changes in fasting blood glucose from baseline to week 48, 96, and 144 of TAF in mFAS and PP populations.
Time frame: week 48, 96, and 144
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