Safety profile of nucleotide analogues is an important issue in view of its widespread use for decades in patients with chronic hepatitis B.
Professor Wong and colleagues of China reviewed and evaluated the latest evidence on the safety profiles of the 6 approved nucleoside analogues.
Relevant articles related to nucleoside analogue safety were selected for review following extensive language- and date-unrestricted, electronic searches of the literature.
Nephrotoxicity has been well reported in patients receiving older generations of nucleotide analogues, namely adefovir dipivoxil and tenofovir disoproxil fumarate.
Risks of renal failure and renal replacement therapy were similar in patients treated with nucleoside analogues versus nucleotide analogues in real-life setting.
The researchers found bone toxicity is closely related to nucleoside analogue effect on renal proximal tubular and phosphaturia.
Real-life data demonstrated increased risk of hip fracture in patients receiving adefovir but not tenofovir disoproxil fumarate.
|Muscular toxicity may be seen in telbivudine-treated patients
|Alimentary Pharmacology and Therapeutics
The newly approved tenofovir alafenamide has improved renal and bone safety profiles compared to tenofovir disoproxil fumarate.
Long-term use of nucleoside analogues, for example, entecavir does not increase the risk of other cancers.
The team discovered that muscular toxicity may be seen in telbivudine-treated patients so regular monitoring is advised.
Peripheral neuropathy and lactic acidosis are rare adverse events.
Latest international guidelines support the use of tenofovir disoproxil fumarate, telbivudine and lamivudine during pregnancy.
The research team observed that breastfeeding is not contraindicated during tenofovir disoproxil fumarate therapy.
Professor Wong's team concludes, "Long-term safety profile of nucleoside analogues is now better defined with more data from large real-life cohorts and clinical trials with long-term follow-up."
"The new nucleotide analogue, tenofovir alafenamide, is now available with favourable renal and bone safety profiles."