Efficacy and Safety of Tenofovir Amibufenamide and Tenofovir Alafenamide for First‐Time HBV‐Related Decompensated Cirrhosis

ABSTRACT Clinical studies of tenofovir amibufenamide (TMF) and tenofovir alafenamide (TAF) treatment in patients with HBV‐related decompensated cirrhosis (HBV‐DC) are limited. This study evaluated the efficacy and safety of TMF versus TAF in naive‐treated patients with first‐time HBV‐DC. Based on the antiviral drug used, patients were categorised into the TMF group and the TAF group. Virological and serological responses, hepatic and renal functions and blood lipid changes in both groups were evaluated during 48 weeks of treatment. A total of 98 patients were enrolled, 45 in the TMF group and 53 in the TAF group. At 48 weeks of treatment, the proportions of patients who achieved complete virological response (CVR) were 85.7% and 90.7%, respectively ( p = 0.791). Improvement of at least 2 points in Child–Turcotte–Pugh scores was observed in 64.3% versus 79.1% ( p = 0.169) of the patients. There were no significant changes in serum creatinine, estimated glomerular filtration rate or total cholesterol from baseline to week 48 between the two groups. Cystatin C remained stable in the TMF group but increased over time in the TAF group ( p < 0.001). Low‐density lipoprotein cholesterol remained stable in the TMF group but increased significantly in the TAF group at week 48 ( p = 0.015). These results suggest that both TMF and TAF can rapidly suppress HBV replication, improve hepatic function and have no negative effects on renal function among patients with HBV‐DC. Regarding lipid metabolism, both showed a better safety, while regular monitoring of blood lipid levels is recommended.