Clin Mol Hepatol.
2017 Mar;23(1):66-73. 10.3350/cmh.2016.0060.
Tenofovir has inferior efficacy in adefovir-experienced chronic hepatitis B patients compared to nucleos(t)ide-naïve patients
- Affiliations
-
- 1Department of Internal Medicine, Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea.
- 2Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea. pindra@empal.com, jhleemd@gmail.com
- 3Department of Gastroenterology and Hepatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
- 4Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea.
- 5Department of Internal Medicine, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
- 6Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
- 7Department of Internal Medicine, Ewha Womans University School of Medicine Liver Center, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.
- 8INSERM Unité 1052, Cancer Research Center of Lyon, Hospices Civils de Lyon, Lyon University, Lyon, France.
- KMID: 2412116
- DOI: http://doi.org/10.3350/cmh.2016.0060
Abstract
- BACKGROUND/AIMS
A recent study reported that entecavir had inferior efficacy in nucleos(t)ide analogue (NA)-experienced chronic hepatitis B (CHB) patients compared to NA-naïve patients. We sought to compare the efficacy of tenofovir disoproxil fumarate (TDF) in NA-experienced and NA-naïve CHB patients.
METHODS
We retrospectively enrolled 252 consecutive patients who had a serum hepatitis B virus (HBV) DNA level greater than 2,000 IU/mL at the initiation of TDF treatment and who received TDF for at least 6 months. Complete virologic suppression (CVS) was defined as undetectable serum HBV DNA. We generated a multivariate Cox proportional-hazard model to examine predictive factors that were independently associated with time to CVS.
RESULTS
The mean age of patients was 48.2 years, and the cohort included 181 NA-naïve patients and 71 NA-experienced patients. The median duration of TDF treatment was 14.4 (interquartile range, 9.5-17.8) months. A total of 167 (92.3%) of 181 NA-naïve patients achieved CVS, and 60 (84.5%) of 71 NA-exposed patients achieved CVS. Forty-nine (89.1%) of 55 patients who previously took an NA aside from adefovir and 11 (68.8%) of 16 adefovir-experienced patients achieved CVS. In multivariable analysis, previous adefovir exposure significantly influenced time to CVS (hazard ratio, 0.37; 95% confidence interval, 0.19-0.72; P=0.003), after adjusting for HBeAg positivity, baseline HBV DNA level and cirrhosis.
CONCLUSIONS
Tenofovir had inferior efficacy in adefovir-experienced CHB patients compared to NA-naïve patients. The response of patients with previous adefovir exposure to TDF monotherapy should be monitored closely.
Keyword
MeSH Terms
-
Adenine/*analogs & derivatives/therapeutic use
Adult
Antiviral Agents/*therapeutic use
DNA, Viral/blood/genetics
Drug Administration Schedule
Drug Resistance, Viral
Female
Hepatitis B e Antigens/blood
Hepatitis B virus/genetics
Hepatitis B, Chronic/complications/*drug therapy/virology
Humans
Liver Cirrhosis/complications
Male
Middle Aged
Multivariate Analysis
Nucleotides/chemistry/therapeutic use
Organophosphonates/*therapeutic use
Proportional Hazards Models
Retrospective Studies
Tenofovir/*therapeutic use
Treatment Outcome
Antiviral Agents
DNA, Viral
Hepatitis B e Antigens
Nucleotides
Organophosphonates
Tenofovir
Adenine
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