Entecavir plus tenofovir versus entecavir plus adefovir in chronic hepatitis B patients with a suboptimal response to lamivudine and adefovir combination therapy.
10.3350/cmh.2015.21.3.242
- Author:
Jung Gil PARK
1
;
Soo Young PARK
Author Information
1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, CHA University, CHA Gumi Medical Center, Gumi, Korea.
- Publication Type:Original Article ; Comparative Study
- Keywords:
Chronic hepatitis B;
Lamivudine resistance;
Combination therapy;
Entecavir;
Tenofovir
- MeSH:
Adenine/*analogs & derivatives/therapeutic use;
Adult;
Antiviral Agents/*therapeutic use;
DNA, Viral/blood;
Drug Resistance, Viral;
Drug Therapy, Combination;
Female;
Genotype;
Guanine/*analogs & derivatives/therapeutic use;
Hepatitis B virus/genetics/isolation & purification;
Hepatitis B, Chronic/*drug therapy/virology;
Humans;
Lamivudine/*therapeutic use;
Male;
Middle Aged;
Odds Ratio;
Organophosphonates/*therapeutic use;
Real-Time Polymerase Chain Reaction;
Retrospective Studies;
Tenofovir/*therapeutic use;
Viral Load
- From:Clinical and Molecular Hepatology
2015;21(3):242-248
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: We compared the efficacies of entecavir (ETV) plus tenofovir (TDF) and ETV plus adefovir (ADV) in chronic hepatitis B (CHB) patients with genotypic resistance to lamivudine (LAM) who showed a suboptimal response to LAM and ADV combination therapy. METHODS: We reviewed 63 CHB patients with genotypic resistance to LAM who showed a suboptimal response to LAM and ADV combination therapy. Among these patients, 30 were treated with ETV + ADV and 33 were treated with ETV + TDF for 12 months. RESULTS: The only baseline characteristic that differed significantly between the two groups was the ETV resistance profile. The rate of a virologic response [serum hepatitis B virus (HBV) DNA level of <20 IU/mL] was significant higher for ETV+TDF than for ETV+ADV over 12 months (57.6% vs. 23.3%, P=0.006, at 6 months; 84.8% vs. 26.7%, P<0.001, at 12 months). The probability of a virologic response was significantly increased in ETV+TDF (P<0.001, OR=54.78, 95% CI=7.15-419.54) and decreased in patients with higher baseline viral loads (P=0.001, OR=0.18, 95% CI=0.07-0.50) in multivariate analysis. No serious adverse event occurred during the study period. CONCLUSIONS: In patients with CHB who showed a suboptimal response to LAM and ADV combination therapy, ETV+TDF was superior to ETV+ADV in achieving a virologic response regardless of the HBV resistance profile. Further large-scale and long-term follow-up prospective studies are needed to explain these results.
