Tenofovir-based rescue therapy for chronic hepatitis B patients who had failed treatment with lamivudine, adefovir, and entecavir

• Published in: Journal of gastroenterology and hepatology Vol. 30; no. 10; pp. 1514 - 1521
• Main Authors: Kim, Byung Gyu, Jung, Seok Won, Kim, Eun Hye, Kim, Jae Hee, Park, Ju Hwan, Sung, Shi Jung, Park, Bo Ryung, Kim, Min-Ho, Kim, Chang Jae, Lee, Byung Uk, Park, Jae Ho, Jeong, In Du, Bang, Sung-Jo, Shin, Jung Woo, Park, Neung Hwa
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.10.2015
• Subjects: Adenine - analogs & derivatives; Adult; Antiviral Agents - administration & dosage; chronic hepatitis B; DNA, Viral - blood; Drug Resistance, Multiple; Drug Therapy, Combination; Female; Guanine - administration & dosage; Guanine - analogs & derivatives; Hepatitis B virus - genetics; Hepatitis B, Chronic - drug therapy; Hepatitis B, Chronic - virology; Humans; Lamivudine - administration & dosage; Male; Middle Aged; multidrug resistance; Multivariate Analysis; Organophosphonates; tenofovir; Tenofovir - administration & dosage; Treatment Failure; chronic hepatitis B; multidrug resistance; tenofovir
• ISSN: 0815-9319; 1440-1746; 1440-1746
• DOI: 10.1111/jgh.12993

Background and Aim In the past decade, many chronic hepatitis B (CHB) patients have undergone sequential treatment with lamivudine (LAM), adefovir (ADV), and entecavir (ETV) to manage antiviral resistance or insufficient suppression of HBV‐DNA. Very limited data are available on the efficacy of tenofovir (TDF) rescue regimens in patients with multidrug resistance (MDR). Methods We investigated the antiviral efficacy of TDF/LAM combination therapy versus TDF/ETV combination therapy in 52 patients who failed three previous antiviral therapies. Results The study subjects were treated with TDF/LAM combination therapy (n = 25) or TDF/ETV combination therapy (n = 27) for more than six months. Virologic response (VR) occurred in 39 (75%) patients (19 patients belonged to the TDF/LAM group and 20 patients belonged to the TDF/ETV group). The VR rates were not different between the TDF/LAM and TDF/ETV groups (56.0% vs 51.9% at month 12, and 72.0% vs 78.8% at month 18; log rank P = 0.515). In addition, treatment efficacy of TDF/LAM combination or TDF/ETV combination was not statistically different according to types of MDR. In multivariate analysis, absolute HBV‐DNA level at the start of TDF rescue treatment (P < 0.001; OR, 0.452; 95% CI, 0.306–0.666) was only significantly associated with VR. Conclusions TDF/ETV combination therapy was not associated with higher rate of VR compared with TDF/LAM combination therapy in MDR CHB patients. These results raise the suspicion about the superiority of the combination therapy over TDF monotherapy. The lower HBV‐DNA levels at the start of TDF‐based rescue therapy were associated with higher VR.