In Vitro and In Vivo Renoprotective Effects of Telbivudine in Chronic Hepatitis B Patients Receiving Nucleotide Analogue
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Renal toxicity of adefovir disoproxil (ADV) and tenofovir disoproxil fumarate (TDF) is a significant concern in chronic hepatitis B (CHB) patients. Early observational clinical data suggested that telbivudine (LdT) might have renoprotective effects.
In this prospective study, consecutive CHB patients on combined lamivudine (LAM) + ADV/TDF were switched to LdT + ADV/TDF at recruitment and were followed up for 24 months. Estimated glomerular filtration rate (eGFR) was calculated with the modification of diet in renal disease equation. The effects of LdT on cell viability and expression of kidney injury or apoptotic biomarkers were investigated in cultured renal tubular epithelial cell line HK-2.
Thirty-one patients (median age 55 years, 90.3% male) were recruited (54.8% TDF: 45.2% ADV). Serum HBV DNA was undetectable at all time points. Median eGFR was 70.2 (IQR 62.6–77.9) and 81.5 (IQR 63.6–99.1) mL/min/1.73 m2 at baseline and 24 months, respectively (p < 0.001). Downstaging of chronic kidney disease was observed in eight (25.8%) patients and was more common in ADV-treated compared to TDF-treated patients (7/8 vs. 1/17, p = 0.011; OR 16, 95% CI 1.643–155.766, p = 0.017). In vitro data showed that adding LdT to ADV or TDF was associated with improved cell viability and lower expression of injury and apoptotic biomarkers compared with ADV or TDF alone. Treatment was prematurely discontinued in four(12.9%) patients due to myalgia.
Clinical and in vitro data suggest that LdT has renoprotective effects in patients on long-term ADV/TDF treatment. LdT may be considered as an adjuvant therapy in this special group of patients with renal impairment (NCT03778567).
KeywordsHBV Antiviral Nephrotoxicity Tenofovir Nucleoside analogues
This study was sponsored by Novartis Pharmaceuticals (Hong Kong) Limited, which was not involved in the study design and execution, data analyses, and writing of manuscript. The in vitro studies were supported by the Hong Kong Society of Nephrology Research Grant 2017 awarded to Mr. Paul Lee and Dr. Desmond Yap, and the Hong Kong College of Physicians Young Investigator Research Grant 2016 awarded to Dr. Desmond Yap.
Compliance with Ethical Standards
Conflict of interest
WK Seto is an advisory board member of Gilead Sciences and Bristol-Myers Squibb and received speaker fees from Gilead Sciences, Bristol-Myers Squibb, and Novartis. J Fung received research funding from Novartis. CL Lai received speaker fees from Bristol-Myers Squibb, Novartis and Gilead Sciences, and is an advisory board member of Gilead Sciences. MF Yuen received speaker fees from GlaxoSmithKline, Bristol-Myers Squibb, Novartis, and Gilead Sciences; and received research funding and is an advisory board member of Bristol-Myers Squibb, Novartis, and Gilead Sciences. The remaining authors have no conflict of interest.
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