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Tenofovir‐based rescue therapy for chronic hepatitis B patients who had failed treatment with lamivudine, adefovir, and entecavir
Author(s) -
Kim Byung Gyu,
Jung Seok Won,
Kim Eun Hye,
Kim Jae Hee,
Park Ju Hwan,
Sung Shi Jung,
Park Bo Ryung,
Kim MinHo,
Kim Chang Jae,
Lee Byung Uk,
Park Jae Ho,
Jeong In Du,
Bang SungJo,
Shin Jung Woo,
Park Neung Hwa
Publication year - 2015
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12993
Subject(s) - entecavir , adefovir , medicine , combination therapy , lamivudine , gastroenterology , tenofovir , hepatitis b , rescue therapy , hepatitis b virus , virology , virus , human immunodeficiency virus (hiv)
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 .

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