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

Authors
 S. Lee  ;  S. H. Ahn  ;  K. S. Jung  ;  D. Y. Kim  ;  B. K. Kim  ;  S. U. Kim  ;  O. Baatarkhuu  ;  H. J. Ku  ;  K. Han  ;  J. Y. Park 
Citation
 Journal of Viral Hepatitis, Vol.24(2) : 141-147, 2017 
Journal Title
 Journal of Viral Hepatitis 
ISSN
 1352-0504 
Issue Date
2017
MeSH
Adult ; Aged ; Aged, 80 and over ; Antiviral Agents/pharmacology ; Antiviral Agents/therapeutic use* ; DNA, Viral/blood ; Drug Resistance, Viral* ; Female ; Guanine/analogs & derivatives* ; Guanine/pharmacology ; Guanine/therapeutic use ; Hepatitis B virus/drug effects* ; Hepatitis B virus/isolation & purification ; Hepatitis B, Chronic/drug therapy* ; Hepatitis B, Chronic/virology ; Humans ; Lamivudine/pharmacology ; Male ; Middle Aged ; Tenofovir/pharmacology ; Tenofovir/therapeutic use* ; Treatment Outcome ; Viral Load ; Young Adult
Keywords
chronic hepatitis B ; entecavir ; multidrug resistance ; tenofovir ; virologic response
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.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/jvh.12623/abstract
DOI
10.1111/jvh.12623
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Jung, Kyu Sik(정규식)
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154314
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