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J Viral Hepat. 2017 Feb;24(2):141-147. doi: 10.1111/jvh.12623. Epub 2016 Oct 20.

Tenofovir versus tenofovir plus entecavir for chronic hepatitis B with lamivudine resistance and entecavir resistance.

Lee S1,2, Ahn SH3,4, Jung KS3, Kim DY3,4, Kim BK3,4, Kim SU3,4, Baatarkhuu O3,5, Ku HJ3, Han K3,4, Park JY3,4.

Author information

1
Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon Metropolitan City, Korea.
2
Institute for Integrative Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon Metropolitan City, Korea.
3
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
4
Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
5
Department of Infectious Diseases, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.

Abstract

We compared the viral suppressive efficacy of tenofovir disoproxil fumarate (TDF) mono-rescue therapy (TDF group) and TDF plus entecavir (ETV) combination-rescue therapy (TDF + ETV group) in chronic hepatitis B (CHB) patients with lamivudine resistance and entecavir resistance. One hundred and thirty-three CHB patients with lamivudine and entecavir resistance were investigated. Ninety-six patients were treated with TDF and 37 with TDF + ETV for at least 6 months. We compared the virologic response rate (HBV DNA level <20 IU/mL) between the two groups and identified the predictive factors of treatment outcome. There were no significant differences between the two groups in demographic characteristics. Up to 24 months [median: 18 (range 6-24) months], 85.4% and 89.2% of the TDF group and TDF + ETV group, respectively, achieved a virologic response (P=.068). Only the HBV DNA level at baseline was significantly associated with a virologic response in the multivariate analysis. In a subanalysis of patients with HBV DNA levels ≥4 log (IU/mL) at baseline, a higher proportion of patients in the TDF + ETV group than the TDF group achieved a virologic response (92.9% vs 68.3%; P<.001), while 90% of patients with HBV DNA (IU/mL) levels <4 log in all both TDF and TDF + ETV groups achieved a virologic response. TDF mono-rescue therapy is a reasonable option in patients with lamivudine resistance and entecavir resistance. However, the combination strategy should be considered in patients with high baseline HBV DNA levels.

KEYWORDS:

chronic hepatitis B; entecavir; multidrug resistance; tenofovir; virologic response

PMID:
27766731
DOI:
10.1111/jvh.12623
[Indexed for MEDLINE]

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