臨床消化器病学ジャーナル

Background: The effect of Tenofovir Alafenamide (TAF) therapy on viral suppression and hepatic function in patients of Hepatitis B Virus (HBV) related decompensated cirrhosis is not known. Aim of this study was to evaluate the efficacy and safety of TAF therapy in these patients.

Methods: We analyzed 55 consecutive HBV-infected treatment naive patients with decompensated cirrhosis treated with 25 mg/day TAF and evaluated the treatment outcomes. Treatment efficacy was evaluated by measuring virological, serological, biochemical responses and changes in hepatic function over period of 6 month.

Results: At month 6, undetectable HBV-DNA level, HBeAg loss, HBeAg seroconversion and ALT normalization was seen in 65.2%, 22.2%, 5.5% and 74.5% patients respectively. Virological and biochemical responses were similar in HBeAg positive and negative patients. CTP (8.38 ± 1.56 vs. 6.73 ± 1.05), MELD-Na (16.00 ± 6.22 vs. 12.00 ± 4.50), bilirubin [1.65 (0.4-16.7) mg/dL vs. 1.20 (0.7-3.2) mg/dL], INR (1.45 ± 0.35 vs. 1.32 ± 0.32), albumin (2.88 ± 0.58 vs. 3.05 ± 0.39 g/dL), and ALT (68 IU/L (19-390) vs. 36 IU/L (11-94)) was significantly improved after 6 months of TAF treatment. 45.5% and 47.2% patients showed improvement in CTP and MELD-Na score by ≥ 2 points after 6 months. There was no significant difference in eGFR measured respectively at baseline and at month 6 (94.82 ± 38.66 vs. 92.93 ± 25.75 mL./minute, p=0.64).

Conclusion: TAF therapy is effective in decreasing HBV DNA levels, normalizing ALT, improving hepatic function and is well tolerated in decompensated cirrhosis patients.

Leflunomide has been reported to impair ulcer healing by inhibiting DNA synthesis. To the best of our knowledge, we report a first case of non-healing gastric ulcer in a patient treated with leflunomide for rheumatoid arthritis. Patient developed gastric ulcer secondary to NSAID use which did not heal for several years despite being on PPI therapy and avoiding NSAIDs. Gastric ulcer healing was documented after stopping leflunomide.