Letter to the Editor Open Access
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2024; 30(26): 3261-3263
Published online Jul 14, 2024. doi: 10.3748/wjg.v30.i26.3261
Effectiveness and safety of tenofovir amibufenamide in chronic hepatitis B patients
Li-Yang Meng, Chao-Ting Yang, The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Jian-Feng Bao, Jin-Song Huang, Department of Hepatology, Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou 310023, Zhejiang Province, China
ORCID number: Jin-Song Huang (0000-0003-1254-1181).
Author contributions: Meng LY and Yang CT wrote the manuscript with the support from Huang JS; Bao JF edited this letter; Huang JS conceived the original idea.
Supported by Biomedical Enterprise Project of Hangzhou Science and Technology Bureau, No. 2021WJCY061 and No. 2022WJC230.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Song Huang, Doctor, Chief Doctor, Department of Hepatology, Hangzhou Xixi Hospital, Zhejiang University School of Medicine, No. 2 Hengbu Road, Hangzhou 310023, Zhejiang Province, China. huangjinsongyz@126.com
Received: April 28, 2024
Revised: May 30, 2024
Accepted: June 21, 2024
Published online: July 14, 2024
Processing time: 72 Days and 8 Hours


This letter to the editor relates to the study entitled “Tenofovir amibufenamide vs tenofovir alafenamide for treating chronic hepatitis B: A real-world study”, which was recently published by Peng et al. Hepatitis B virus infection represents a significant health burden worldwide and can lead to cirrhosis and even liver cancer. The antiviral drugs currently used to treat patients with chronic hepatitis B infection still have many side effects, so it is crucial to identify safe and effective drugs to inhibit viral replication.

Key Words: Tenofovir amibufenamide, Chronic hepatitis B, Non-alcoholic fatty liver disease, Alanine transaminase normalization, Virological response

Core Tip: It is well known that every chronic hepatitis B (CHB) patient should receive antiviral therapy. Although nucleos(t)ide analogs are still the first choice for CHB treatment, they are associated with many side effects, such as renal damage, osteoporosis, and lipid metabolism disorders. Therefore, as a new antiviral drug in China, tenofovir amibufenamide (TMF) is as effective as tenofovir alafenamide (TAF) in treating CHB and has comparable safety profiles, which suggests that TMF may be a viable alternative to TAF for CHB treatment.


We read with interest the retrospective study by Peng et al[1] titled “Tenofovir amibufenamide vs tenofovir alafenamide for treating chronic hepatitis B: A real-world study” published in the World Journal of Gastroenterology. The results of this study highlight the effectiveness and safety of tenofovir amibufenamide (TMF) for 48 weeks in patients with chronic hepatitis B (CHB). TMF may replace tenofovir alafenamide (TAF) for CHB treatment.

CHB remains the leading cause of liver cirrhosis and cancer in China[2]. Nucleos(t)ide analogs (NAs) are still the first choice for CHB treatment. Most patients receiving antiviral therapy can achieve long-term hepatitis B virus (HBV) DNA suppression. However, long-term follow-up studies have revealed that drugs that inhibit HBV replication, such as those aimed at reducing the risk of renal damage and osteoporosis and affecting lipid metabolism, are still ineffective[3]. Therefore, it is still important to find new drugs with the best antiviral effects and the fewest side effects. TMF is a newly launched antiviral drug in China, and there is still a lack of real-world research data in the Chinese population. Therefore, we endorse this literature to evaluate the safety and effectiveness of TMF in the treatment of patients with CHB patients in China, which has made outstanding contributions to the treatment of patients with CHB. We want to emphasize the following points about this study. First, this retrospective study has inherent limitations: The nonrandom selection of antiviral drugs can impact the clinical prognosis under investigation.

Second, the exclusion of CHB patients with concomitant nonalcoholic fatty liver disease (NAFLD) deserves consideration in research studies. While the study exclusion criteria (study design and patient selection) did mention CHB concurrent with NAFLD, data from “Table 1: Baseline characteristics of the study population” revealed that there were percentages of CHB patients with NAFLD in the TMF and TAF groups. Consequently, this study did not exclude CHB patients with NAFLD from its analysis. The findings from a retrospective study suggest that the presence of NAFLD can compromise the effectiveness of NA therapy in hepatitis B e antigen-positive CHB patients, leading to diminished rates of biochemical response and fibrosis improvement[4]. Additionally, liver biopsy is the most accurate modality for diagnosing and staging the severity of liver fibrosis, but this method is invasive and associated with potential complications. As a noninvasive alternative, liver stiffness measurement based on FibroScan was utilized to diagnose liver cirrhosis in this study[5]. However, it should be noted that the reliability of diagnosing cirrhosis based on liver stiffness measurement may be compromised by severe hepatic steatosis. The presence of significant hepatic steatosis affects the degree of hepatic fibrosis and reduces the specificity of liver fibrosis detection[6]. Therefore, the exclusion of CHB patients with NAFLD is imperative due to the detrimental impact of hepatic steatosis on the progression of fibrosis and compromised antiviral effectiveness. It is recommended to compare the effectiveness of this antiviral between CHB patients with and without NAFLD if CHB patients with NAFLD cannot be excluded.

Moreover, it is essential to note that NAs require time to inhibit the replication of HBV[7]. Therefore, in attempts to protect patient safety, researchers have explored combining NAs with various liver protection drugs. However, this approach may impact the accuracy of the study results. It is important to recognize that different liver protection drugs can have varying effects on outcomes, such as the alanine aminotransferase normalization rate and blood lipid metabolism. To increase the validity of the findings and ensure greater comparability between groups, we recommend using the same liver protection drugs for the TMF and TAF groups.

Peng et al[1] have made a significant contribution to the effectiveness and safety profile of TMF in CHB patients. We agree with the limitations of demonstrating the safety of TMF, as clearly described by the author. The points we propose are all related to the antiviral effectiveness of TMF in this study. Nonetheless, because of some influencing factors, the effectiveness of TMF remains to be further demonstrated. It is advisable to exclude CHB patients with NAFLD and reduce the impact of different hepatoprotective drugs.


Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Gastroenterology and hepatology

Country of origin: China

Peer-review report’s classification

Scientific Quality: Grade B, Grade C

Novelty: Grade B, Grade B

Creativity or Innovation: Grade B, Grade B

Scientific Significance: Grade B, Grade B

P-Reviewer: Sira MM S-Editor: Wang JJ L-Editor: A P-Editor: Zhang L

1.  Peng WT, Jiang C, Yang FL, Zhou NQ, Chen KY, Liu JQ, Peng SF, Fu L. Tenofovir amibufenamide vs tenofovir alafenamide for treating chronic hepatitis B: A real-world study. World J Gastroenterol. 2023;29:5907-5918.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
2.  Liu J, Liang W, Jing W, Liu M. Countdown to 2030: eliminating hepatitis B disease, China. Bull World Health Organ. 2019;97:230-238.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 141]  [Cited by in F6Publishing: 259]  [Article Influence: 51.8]  [Reference Citation Analysis (0)]
3.  Terrault NA, Lok ASF, McMahon BJ, Chang KM, Hwang JP, Jonas MM, Brown RS Jr, Bzowej NH, Wong JB. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67:1560-1599.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2290]  [Cited by in F6Publishing: 2330]  [Article Influence: 388.3]  [Reference Citation Analysis (0)]
4.  Tang Y, Fan R, Lan Z, Xie Q, Zhang J, Liang X, Wang H, Tan D, Cheng J, Chen S, Ning Q, Bai X, Xu M, Chen X, Niu J, Shi J, Ren H, Gao Z, Wang M, Dou X, Hou J, Sun J. Impact of nonalcoholic fatty liver disease status change on antiviral efficacy of nucleos(t)ide analogues in HBeAg-positive chronic hepatitis B. J Med Virol. 2023;95:e28501.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 2]  [Reference Citation Analysis (0)]
5.  Younossi ZM, Loomba R, Anstee QM, Rinella ME, Bugianesi E, Marchesini G, Neuschwander-Tetri BA, Serfaty L, Negro F, Caldwell SH, Ratziu V, Corey KE, Friedman SL, Abdelmalek MF, Harrison SA, Sanyal AJ, Lavine JE, Mathurin P, Charlton MR, Goodman ZD, Chalasani NP, Kowdley KV, George J, Lindor K. Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis. Hepatology. 2018;68:349-360.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 230]  [Cited by in F6Publishing: 259]  [Article Influence: 43.2]  [Reference Citation Analysis (0)]
6.  Kumada T, Toyoda H, Yasuda S, Ogawa S, Gotoh T, Ito T, Tada T, Tanaka J. Liver Stiffness Measurements by 2D Shear-Wave Elastography: Effect of Steatosis on Fibrosis Evaluation. AJR Am J Roentgenol. 2022;219:604-612.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
7.  Xia Y, Liang TJ. Development of Direct-acting Antiviral and Host-targeting Agents for Treatment of Hepatitis B Virus Infection. Gastroenterology. 2019;156:311-324.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 76]  [Cited by in F6Publishing: 76]  [Article Influence: 15.2]  [Reference Citation Analysis (0)]