Clin Mol Hepatol.  2015 Sep;21(3):242-248. 10.3350/cmh.2015.21.3.242.

Entecavir plus tenofovir versus entecavir plus adefovir in chronic hepatitis B patients with a suboptimal response to lamivudine and adefovir combination therapy

• Park JG
• Park SY

• KMID: 2351024
• DOI: http://doi.org/10.3350/cmh.2015.21.3.242

Abstract

BACKGROUND/AIMS
We compared the efficacies of entecavir (ETV) plus tenofovir (TDF) and ETV plus adefovir (ADV) in chronic hepatitis B (CHB) patients with genotypic resistance to lamivudine (LAM) who showed a suboptimal response to LAM and ADV combination therapy.
METHODS
We reviewed 63 CHB patients with genotypic resistance to LAM who showed a suboptimal response to LAM and ADV combination therapy. Among these patients, 30 were treated with ETV + ADV and 33 were treated with ETV + TDF for 12 months.
RESULTS
The only baseline characteristic that differed significantly between the two groups was the ETV resistance profile. The rate of a virologic response [serum hepatitis B virus (HBV) DNA level of <20 IU/mL] was significant higher for ETV+TDF than for ETV+ADV over 12 months (57.6% vs. 23.3%, P=0.006, at 6 months; 84.8% vs. 26.7%, P<0.001, at 12 months). The probability of a virologic response was significantly increased in ETV+TDF (P<0.001, OR=54.78, 95% CI=7.15-419.54) and decreased in patients with higher baseline viral loads (P=0.001, OR=0.18, 95% CI=0.07-0.50) in multivariate analysis. No serious adverse event occurred during the study period.
CONCLUSIONS
In patients with CHB who showed a suboptimal response to LAM and ADV combination therapy, ETV+TDF was superior to ETV+ADV in achieving a virologic response regardless of the HBV resistance profile. Further large-scale and long-term follow-up prospective studies are needed to explain these results.

Keyword

Chronic hepatitis B; Lamivudine resistance; Combination therapy; Entecavir; Tenofovir

MeSH Terms

Adenine/*analogs & derivatives/therapeutic use
Adult
Antiviral Agents/*therapeutic use
DNA, Viral/blood
Drug Resistance, Viral
Drug Therapy, Combination
Female
Genotype
Guanine/*analogs & derivatives/therapeutic use
Hepatitis B virus/genetics/isolation & purification
Hepatitis B, Chronic/*drug therapy/virology
Humans
Lamivudine/*therapeutic use
Male
Middle Aged
Odds Ratio
Organophosphonates/*therapeutic use
Real-Time Polymerase Chain Reaction
Retrospective Studies
Tenofovir/*therapeutic use
Viral Load
Adenine
Antiviral Agents
DNA, Viral
Guanine
Lamivudine
Organophosphonates
Tenofovir