Background and Aims: Tenofovir alafenamide (TAF) has similar efficacy to tenofovir disoproxil fumarate (TDF) but with improved renal and bone safety in chronic hepatitis B patients studied outside of China. We report 3-year results from two phase 3 studies with TAF in China (Clinicaltrials. gov: NCT02836249 and NCT02836236). Methods: Chinese hepatitis B e antigen (HBeAg)-positive and -negative chron-ic hepatitis B patients with viremia and elevated alanine aminotransferase were randomized 2:1 to TAF or TDF treat-ment groups and treated in a double-blind fashion for 144 weeks (3 years). Efficacy responses were assessed by indi-vidual study while safety was assessed by a pooled analysis. Results: Of the 334 patients (180 HBeAg-positive and 154 HBeAg-negative) randomized and treated, baseline charac-teristics were similar between groups. The overall mean age was 38 years and 73％ were male. The mean HBV DNA was 6.4 log10 IU/mL. The median alanine aminotransferase was 88 U/L, and 37％ had a history of antiviral use. At week 144, the proportion with HBV DNA <29 IU/mL was similar among the two groups, with TAF at 83％ vs. TDF at 79％, and TAF at 93％ vs. TDF at 92％ for the HBeAg-positive and -negative patients, respectively. In each study, higher pro-portions of TAF than TDF patients showed normalized ala-nine aminotransferase (via the American Association for the Study of Liver Diseases and the China criteria) and showed loss of HBsAg; meanwhile, the HBeAg seroconversion rates were similar. Treatment was well-tolerated among the TAF patients, who showed a smaller median decline in creati-nine clearance (?0.4 vs. ?3.2 mL/min; p=0.014) and less percentage change in bone mineral density vs. TDF at hip (?0.95％ vs. ?1.93％) and spine (+0.35％ vs. ?1.40％). Conclusions: In chronic hepatitis B patients from China, TAF treatment provided efficacy similar to TDF but with bet-ter renal and bone safety at 3 years.