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

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 teno...

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Published inJournal 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
LanguageEnglish
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
Online AccessGet full text
ISSN0815-9319
1440-1746
1440-1746
DOI10.1111/jgh.12993

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Abstract 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.
AbstractList 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). We investigated the antiviral efficacy of TDF/LAM combination therapy versus TDF/ETV combination therapy in 52 patients who failed three previous antiviral therapies. 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. 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.
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.
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).BACKGROUND AND AIMIn 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).We investigated the antiviral efficacy of TDF/LAM combination therapy versus TDF/ETV combination therapy in 52 patients who failed three previous antiviral therapies.METHODSWe investigated the antiviral efficacy of TDF/LAM combination therapy versus TDF/ETV combination therapy in 52 patients who failed three previous antiviral therapies.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.RESULTSThe 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.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.CONCLUSIONSTDF/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.
Author Park, Neung Hwa
Kim, Byung Gyu
Jung, Seok Won
Kim, Chang Jae
Kim, Jae Hee
Bang, Sung-Jo
Sung, Shi Jung
Kim, Eun Hye
Park, Jae Ho
Lee, Byung Uk
Kim, Min-Ho
Jeong, In Du
Shin, Jung Woo
Park, Ju Hwan
Park, Bo Ryung
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Keywords chronic hepatitis B
multidrug resistance
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European Association for the Study of the Liver. EASL clinical practice guidelines: management of chronic hepatitis B virus infection. J. Hepatol. 2012; 57: 167-185.
2010; 10
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2009; 137
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2009; 50
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2010; 139
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2003; 125
2007; 45
2007; 46
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Snippet Background and Aim In the past decade, many chronic hepatitis B (CHB) patients have undergone sequential treatment with lamivudine (LAM), adefovir (ADV), and...
In the past decade, many chronic hepatitis B (CHB) patients have undergone sequential treatment with lamivudine (LAM), adefovir (ADV), and entecavir (ETV) to...
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SubjectTerms 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
Title Tenofovir-based rescue therapy for chronic hepatitis B patients who had failed treatment with lamivudine, adefovir, and entecavir
URI https://api.istex.fr/ark:/67375/WNG-CFQVL6RV-L/fulltext.pdf
https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fjgh.12993
https://www.ncbi.nlm.nih.gov/pubmed/25973716
https://www.proquest.com/docview/1711539804
Volume 30
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