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Tenofovir-based combination therapy or monotherapy for multidrug-resistant chronic hepatitis B: Long-term data from a multicenter cohort study

Authors
 Hyung Joon Yim  ;  Sang Jun Suh  ;  Young Kul Jung  ;  Seong Gyu Hwang  ;  Yeon Seok Seo  ;  Soon Ho Um  ;  Sae Hwan Lee  ;  Young Seok Kim  ;  Jae Young Jang  ;  In Hee Kim  ;  Hyoung Su Kim  ;  Ji Hoon Kim  ;  Young Sun Lee  ;  Eileen L Yoon  ;  Myeong Jun Song  ;  Jun Yong Park 
Citation
 JOURNAL OF VIRAL HEPATITIS, Vol.27(12) : 1306-1318, 2020-12 
Journal Title
 JOURNAL OF VIRAL HEPATITIS 
ISSN
 1352-0504 
Issue Date
2020-12
Keywords
chronic hepatitis B ; multidrug resistance ; tenofovir ; therapy
Abstract
The treatment of multidrug-resistant (MDR) chronic hepatitis B (CHB) is challenging. Herein, we report a multicenter prospective cohort study for the evaluation of tenofovir disoproxil fumarate (TDF)-based therapy for MDR CHB in a real-life setting. The inclusion criteria comprised patients with resistance to more than two nucleos(t)ide analogue (NA) classes and hepatitis B virus (HBV) DNA level of ≥200 IU/mL. The primary end-point was virologic response (VR), defined as undetectable HBV DNA (<20 IU/mL) after 60 months. A total of 236 patients met the inclusion criteria. The mean HBV DNA level was 4.16 ± 1.44 log IU/mL; 26.7% of patients had liver cirrhosis. Before the initiation of TDF, 33.5%, 44.9% and 21.6% of patients had mutations resistant to L-NA + adefovir, L-NA + entecavir (ETV) and L-NA + adefovir + ETV, respectively. A total of 184 patients received TDF-based combination therapy [TDF + ETV (n = 178) or TDF + L-NA (n = 6)], and 52 patients received TDF monotherapy. In the entire cohort, the VR rates were 77.2%, 89.9% and 92.2% at 12, 36 and 60 months, respectively. The VR rates were not significantly different between the combination therapy and the monotherapy group after 12 (76.2% vs 80.4%, P = .533), 36 (89.8% vs 90.3%, P = 1.000) or 60 (92.9% vs 87.5%, P = .499) months. Also, there was no significant difference in the cumulative VR rates for 5 years between the treatment groups (P = .910). Newly developed antiviral resistance was not observed. TDF-based therapy was effective for the treatment of MDR CHB. The efficacy of TDF monotherapy was not different from that of the TDF-based combination therapy.
Full Text
https://onlinelibrary.wiley.com/doi/10.1111/jvh.13363
DOI
10.1111/jvh.13363
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/180682
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