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Tenofovir versus tenofovir plus entecavir for chronic hepatitis B with lamivudine resistance and entecavir resistance
Author(s) -
Lee S.,
Ahn S. H.,
Jung K. S.,
Kim D. Y.,
Kim B. K.,
Kim S. U.,
Baatarkhuu O.,
Ku H. J.,
Han K.,
Park J. Y.
Publication year - 2017
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.12623
Subject(s) - entecavir , lamivudine , tenofovir , virology , chronic hepatitis , hepatitis a virus , medicine , virus , human immunodeficiency virus (hiv)
Summary We compared the viral suppressive efficacy of tenofovir disoproxil fumarate ( TDF ) mono‐rescue therapy ( TDF group) and TDF plus entecavir ( ETV ) combination‐rescue therapy ( TDF + ETV group) in chronic hepatitis B ( CHB ) patients with lamivudine resistance and entecavir resistance. One hundred and thirty‐three CHB patients with lamivudine and entecavir resistance were investigated. Ninety‐six patients were treated with TDF and 37 with TDF + ETV for at least 6 months. We compared the virologic response rate ( HBV DNA level <20 IU /mL) between the two groups and identified the predictive factors of treatment outcome. There were no significant differences between the two groups in demographic characteristics. Up to 24 months [median: 18 (range 6‐24) months], 85.4% and 89.2% of the TDF group and TDF + ETV group, respectively, achieved a virologic response ( P =.068). Only the HBV DNA level at baseline was significantly associated with a virologic response in the multivariate analysis. In a subanalysis of patients with HBV DNA levels ≥4 log ( IU /mL) at baseline, a higher proportion of patients in the TDF + ETV group than the TDF group achieved a virologic response (92.9% vs 68.3%; P <.001), while 90% of patients with HBV DNA ( IU /mL) levels <4 log in all both TDF and TDF + ETV groups achieved a virologic response. TDF mono‐rescue therapy is a reasonable option in patients with lamivudine resistance and entecavir resistance. However, the combination strategy should be considered in patients with high baseline HBV DNA levels.