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J Med Virol. 2016 Jun;88(6):1027-34. doi: 10.1002/jmv.24427. Epub 2015 Nov 19.

Prediction of virologic response to tenofovir mono-rescue therapy for multidrug resistant chronic hepatitis B.

Lee S1,2,3,4, Park JY1,2, Kim D Y1,2, Kim BK1,2, Kim SU1,2, Song K5, Ku HJ1, Han KH1,2, Ahn SH1,2.

Author information

1
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
2
Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
3
Department of Internal Medicine, Catholic Kwandong University College of medicine, International St. Mary's Hospital, Incheon, Republic of Korea.
4
Institute for Integrative Medicine, Catholic Kwandong University College of medicine, International St. Mary's Hospital, Incheon, Republic of Korea.
5
Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea.

Abstract

Most guidelines suggest combination therapy including nucleoside and nucleotide analogues for the treatment of chronic hepatitis B (CHB) with multidrug resistance (MD-R). However, long-term combination treatment can evoke high costs and safety problems. Therefore, we investigated the efficacy of tenofovir disoproxil fumarate (TDF) mono-rescue therapy for viral suppression in patients with CHB exhibiting MD-R. We reviewed patients with CHB exhibiting antiviral drug resistance treated by TDF mono-rescue therapy from December 2012 to June 2014. The patients were categorized into three groups: lamivudine-resistance (LAM-R) group (n = 290), and LAM-R + adefovir-resistance (ADV-R) group (n = 43), and LAM-R + entecavir-resistance (ETV-R) group (n = 113). We compared the virologic response rate according to the multiplicity of resistance and investigated the predictive factors of a virologic response. For a median of 15 months (range, 6-24 months) of TDF mono-rescue therapy, the cumulative virologic response rates were 82.8, 81.4, and 84.1% in the LAM-R, LAM-R + ADV-R, and LAM-R +‚ÄČETV-R groups, respectively (P = 0.239). Multivariate analysis revealed that multiplicity of resistance did not influence the achievement of a virologic response (P = 0.218). However, the baseline HBV DNA level significantly influenced the achievement of a virologic response for the treatment of CHB with MD-R (P < 0.001). TDF mono-rescue therapy is an appropriate treatment for CHB with MD-R, and the baseline HBV DNA level is a significant predictive factor for a virologic response. These factors should be considered before treating CHB with MD-R.

KEYWORDS:

chronic hepatitis B; multidrug resistance; tenofovir; virologic response

PMID:
26538234
DOI:
10.1002/jmv.24427
[Indexed for MEDLINE]

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