Abstract
OBJECTIVE: The aim of this study was to investigate the long-term effects of tenofovir alafenamide, tenofovir disoproxil fumarate, and entecavir on fibrotic burden and to compare the virological clearance and biochemical improvement times achieved with these drugs. METHODS: The study was designed with treatment-naive, hepatitis B e-antigen-negative chronic hepatitis B patients who started tenofovir alafenamide, tenofovir disoproxil fumarate, or entecavir at a tertiary care hospital. The aspartate aminotransferase-to-platelet ratio index and the fibrosis index based on four factors were used to determine the fibrotic burden. RESULTS: Age, gender, baseline aspartate aminotransferase-to-platelet ratio index and fibrosis index based on four factors values, and fibrosis grades obtained by the biopsy of patients treated with tenofovir alafenamide (n=45), tenofovir disoproxil fumarate (n=65), and entecavir (n=56) were similar (p>0.05 for all). Significant fibrosis regression was observed during the 5-year antiviral therapy period in the tenofovir alafenamide, tenofovir disoproxil fumarate, and entecavir groups. CONCLUSION: Significant regression in aspartate aminotransferase-to-platelet ratio index and fibrosis index based on four factors was observed during tenofovir alafenamide, tenofovir disoproxil fumarate, and entecavir therapy within the first 2 years, and this regression remained stable up to the 5th year. None of the three drugs showed superiority over each other in terms of the pattern of fibrosis regression reflected by aspartate aminotransferase-to-platelet ratio index and fibrosis index based on four factors, average virological response time, and biochemical improvement time.