Tenofovir alafenamide fumarate achieves viral suppression rates comparable to tenofovir disoproxil fumarate in patients with chronic hepatitis B virus infection, with an improved safety profile, highlighting its potential to optimize clinical outcomes while minimizing organ toxicity.
Tenofovir alafenamide fumarate (TAF) appears to be a safer option for the treatment of chronic hepatitis B virus (HBV) than tenofovir disoproxil fumarate (TDF), with similar efficacy, according to study findings published in BMC Infectious Diseases
Researchers conducted a systematic review and meta-analysis to synthesize head-to-head data comparing TAF and TDF for chronic HBV infection. The analysis included 4 randomized controlled trials with a total of 1960 patients. Mean patient age ranged from 38 to 56 years within the trials, which all assessed endpoints at 48 weeks. Two trials included only hepatitis B e-antigen (HBeAg)-negative patients, with the other 2 including both HBeAg-negative and -positive patients
The primary outcome was the suppression of HBV DNA to less than 15 to 29 IU/mL, which did not differ significantly between the TAF and TDF groups in a random-effects model (risk ratio [RR], 1.00; 95% CI, 0.96-1.05; P=.82)
These insights underscore the need for ongoing investigation to optimize treatment strategies for CHB [chronic hepatitis B] patients
Patients who received TAF, however, were more likely to have a normalization of alanine transaminase levels (RR, 1.38; 95% CI, 1.16-1.64; P=.0002) and had smaller reductions in bone mineral density measured at the hip (mean difference [MD], 1.44; 95% CI, 0.98-1.91; P<.00001) and spine (MD, 1.93; 95% CI, 1.42-2.44; P<.00001) compared with those who received TDF. Receipt of TAF was also associated with a lesser increase in serum creatinine concentration (MD, -0.02; 95% CI, -0.03 to -0.01; P<.00001) and smaller drop in estimated glomerular filtration rate (MD, 3.55; 95% CI, 2.97-4.14; P<.00001).
Patients who received TAF vs TDF experienced worse outcomes in regard to low-density lipoprotein (LDL) cholesterol levels, being approximately 5-fold more likely to have levels greater than 190 to 300 mg/dL (RR, 4.95; 95% CI, 1.21-20.29; P=.03). The researchers cautioned that “the estimate is uncertain due to a few events and wide confidence intervals.”
Study limitations include the inability to explore additional outcomes related to bone health and kidney function or additional lipid parameters beyond LDL cholesterol, the relatively small number of trials, the high risk of bias in 2 of the trials, heterogeneity in clinical characteristics across trials, the inability to examine potential differences in longer-term outcomes due to follow-up lasting only 48 weeks, and the fact that all 4 trials were sponsored by the manufacturer of both medications.
According to the researchers, “These insights underscore the need for ongoing investigation to optimize treatment strategies for CHB [chronic hepatitis B] patients.”
Dar MS, Ovais H, Khan AW, et al.Efficacy and safety of tenofovir alafenamide versus tenofovir disoproxil in chronic hepatitis b: a systematic review and meta-analysis of randomized controlled trials.BMC Infect Dis. Published online July 6, 2026. doi:10.1186/s12879-026-13974-4
