title: Tenofovir-based alternate therapies for chronic hepatitis B patients with partial virological response to entecavir.
abstract: Entecavir (ETV) is a first-line antiviral therapy for treating chronic hepatitis B (CHB); however, some patients have suboptimal response to ETV. Currently, there are limited data on how to approach these patients. Therefore, our aim was to compare the effectiveness of two alternate therapies--tenofovir (TDF) monotherapy and combination therapy of ETV+TDF--in CHB patients with ETV partial virological response. We conducted a retrospective study of 68 patients who had partial virological response to ETV, defined as having detectable HBV DNA following at least 12 months of ETV, and were switched to TDF monotherapy (n = 25) or ETV+TDF (n = 43). Patients were seen in seven US liver/community-based clinics and started on ETV between 2005 and 2009. The majority of patients were male; the vast majority were Asian and had positive hepatitis B e antigen (HBeAg). Patients in both groups had similar pretreatment characteristics. Complete viral suppression (CVS) rates with TDF monotherapy and ETV+TDF were similar after 6 months (71% vs 83%, P = 0.23) and 12 months (86% vs 84%, P = 0.85), and there was no statistically significant difference in CVS rates even when only patients with higher HBV DNA levels at switch (>1000 IU/mL) were evaluated. Multivariate analysis indicated that ETV+TDF was not an independent predictor of CVS compared to TDF monotherapy (OR = 1.19, P = 0.63). In conclusion, TDF monotherapy and ETV+TDF are comparable in achieving CVS in CHB patients with partial virological response to ETV. Long-term alternate therapy with one pill (TDF monotherapy) vs two pills (ETV+TDF) could lead to lower nonadherence rates and better treatment outcomes.
authors.affiliation: Medical School, University of Michigan Medical School, Ann Arbor, MI, USA.|Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Lu
authors.affiliation: Medical School, Eastern Virginia Medical School, Norfolk, VA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Yip
authors.affiliation: San Jose Gastroenterology, San Jose, CA, USA.
authors.forename: H
authors.initials: H
authors.lastname: Trinh
authors.affiliation: Division of Gastroenterology and Hepatology, NYU Langone Medical Center, NYU School of Medicine, New York, NY, USA.
authors.forename: C Q
authors.initials: CQ
authors.lastname: Pan
authors.affiliation: Pfleger Liver Institute, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: S-H B
authors.initials: SH
authors.lastname: Han
authors.affiliation: Christopher Wong, MD, San Francisco, CA, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Wong
authors.affiliation: Palo Alto Medical Foundation, Mountain View, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.affiliation: Medical Procare, Flushing, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Chan
authors.affiliation: Stanford Center for Clinical Informatics, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: G
authors.initials: G
authors.lastname: Krishnan
authors.affiliation: Clifford Wong, MD, San Francisco, CA, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Wong
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000097:blood; D004358:Drug Therapy / Q000379:methods; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000068698:Tenofovir / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; C413685:entecavir; D006147:Guanine; D000068698:Tenofovir
keywords: chronic hepatitis B; entecavir; partial virological response; switch; tenofovir