Comparing Tenofovir Alafenamide and Tenofovir Disoproxil Fumarate in reducing hepatocellular carcinoma risk in chronic hepatitis B: a propensity score matching study

초록

Background and aims: Tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF) are both recommended as first-line treatments for antiviral-naïve patients with chronic hepatitis B (CHB). However, it remains controversial which drug is more effective in preventing hepatocellular carcinoma (HCC). We aimed to compare the effects of TAF and TDF on HCC risk. Method: We included 1,628 treatment-naïve CHB patients who underwent antiviral therapy with either a TAF-based regimen (TAF group: n = 335) or TDF only (TDF group: n = 1,293) between 2007 and 2021. The TAF group consisted of patients who received TAF as a firstline treatment and those who switched from TDF to TAF. Propensity score (PS) matching was used to reduce the effects of confounding factors. Results: After PS matching, we analyzed data from 334 patients in the TAF group (mean age: 48.0 ± 11.7 years; 192 men [57.5%]) and 573 patients in the TDF group (mean age: 47.4 ± 11.6 years; 326 men [56.9%]). During a 60-month follow-up, 8 patients in the TAF group (2.4%) and 46 patients in the TDF group (8.0%) developed HCC. TAF treatment was associated with a significantly lower risk of HCC compared to TDF (hazard ratio [HR], 0.34; 95% confidence interval [CI], 0.16–0.72; P < 0.001). In multivariate analysis, factors independently associated with HCC development included age (adjusted HR [aHR], 1.07; P < 0.001), liver cirrhosis (aHR, 2.02; P = 0.045), diabetes (aHR, 4.78; P < 0.001), alcohol use (aHR, 3.07; P = 0.002), and TAF treatment (aHR, 0.22; P < 0.001). Conclusion: TAF treatment was associated with a 66% lower risk of HCC compared to TDF treatment. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.