Tenofovir-based rescue therapy in chronic hepatitis B patients with suboptimal responses to adefovir with prior lamivudine resistance.
We evaluated the efficacy of tenofovir (TDF)-based rescue therapy and compared the outcomes of TDF monotherapy and TDF-based nucleoside analog (NA) combination therapy in patients with suboptimal response (SOR) to adefovir (ADV) with or without NAs in lamivudine (LAM)-resistant chronic hepatitis B. All study subjects received ADV with or without NAs due to prior LAM resistance, and were then switched to TDF-based rescue therapy due to SOR (hepatitis B virus DNA >20 IU/ml after at least 6 months of therapy). A total of 125 patients were eligible. The overall cumulative proportion of complete virologic response (CVR) was 64 of 74 patients (86.5%) at 48 weeks of treatment. During the follow-up period of 48 weeks, there was no significant difference in CVR rate (P = 0.750) between the TDF monotherapy (n = 18) and the TDF with NA groups (n = 107). Patients with ADV genotypic mutations showed inferior antiviral responses to TDF compared with the patients without ADV genotypic mutations, but this was not statistically significant (P = 0.069). Partial virological response to prior ADV therapy showed higher CVR rates compared to patients with non-response at 12 weeks (P = 0.013), but there was no significant difference after 24 (P = 0.076) and 48 weeks (P = 0.198) of treatment. TDF monotherapy is as effective as TDF plus NA combination therapy in patients with SOR to ADV-based rescue therapy and LAM resistance. TDF, with or without NAs, was effective even in cases of ADV resistance.
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
Hyo Jung
HJ
Cho
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
Soon Sun
SS
Kim
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
Sung Jae
SJ
Shin
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
Byung Moo
BM
Yoo
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
Sung Won
SW
Cho
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
Jae Youn
JY
Cheong
D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage*; D056910:Republic of Korea; D012189:Retrospective Studies; D000068698:Tenofovir / Q000008:administration & dosage*; D013997:Time Factors; D055815:Young Adult
D000998:Antiviral Agents; D063065:Organophosphonates; D019259:Lamivudine; C053001:adefovir; D000068698:Tenofovir; D000225:Adenine
adefovir; chronic; combination; drug resistance; drug therapy; hepatitis B; tenofovir; viral