title: Adherence to medication is a more important contributor to viral breakthrough in chronic hepatitis B patients treated with entecavir than in those with Lamivudine.
abstract: Viral breakthrough is related to poor adherence to medication in some chronic hepatitis B patients treated with nucleos(t)ide analogues (NAs). Our study aimed to examine how adherence to medication is associated with viral breakthrough in patients treated with NAs. A total of 203 patients (135 ETV and 68 LAM) were analyzed in this retrospective analysis. Physical examination, serum liver enzyme tests, and hepatitis B virus marker tests were performed at least every 3 months. We reviewed medical records and performed medical interviews regarding to patients' adherence to medication. Adherence rates <90% were defined as poor adherence in the present study. Cumulative viral breakthrough rates were lower in the ETV-treated patients than in the LAM-treated patients (P<0.001). Seven ETV-treated (5.1%) and 6 LAM-treated patients (8.8%) revealed poor adherence to medication (P=0.48). Among ETV-treated patients, 4 (3.1%) of 128 patients without poor adherence experienced viral breakthrough and 3 (42.8%) of 7 patients with poor adherence experienced viral breakthrough (P<0.001). Only 3 of 38 (7.8%) LAM-treated patients with viral breakthrough had poor adherence, a lower rate than the ETV-treated patients (P=0.039). Nucleoside analogue resistance mutations were observed in 50.0% of ETV- and 94.1% of LAM-treated patients with viral breakthrough (P=0.047). Viral breakthrough associated with poor adherence could be a more important issue in the treatment with especially stronger NAs, such as ETV.
authors.affiliation: Departments of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Kamezaki
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kanda
authors.forename: Makoto
authors.initials: M
authors.lastname: Arai
authors.forename: Shuang
authors.initials: S
authors.lastname: Wu
authors.forename: Shingo
authors.initials: S
authors.lastname: Nakamoto
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Chiba
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Maruyama
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fujiwara
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Kanai
authors.forename: Fumio
authors.initials: F
authors.lastname: Imazeki
authors.forename: Fumio
authors.initials: F
authors.lastname: Nomura
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects; D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D006147:Guanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D006515:Hepatitis B virus / Q000187:drug effects / Q000472:pathogenicity; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents; D019259:Lamivudine; C413685:entecavir; D006147:Guanine
keywords: Adherence; Entecavir; Hepatitis B; Lamivudine; Viral Breakthrough.