Efficacy of tenofovir switch therapy for nucleos(t)ide-experienced patients with chronic hepatitis B.

Abstract

BACKGROUND:

Tenofovir disoproxil fumarate has been used in chronic hepatitis B patients with suboptimal virologic response to nucleos(t)ide analogues. The efficacy of tenofovir switch therapy has not been well studied in Asian patients.

AIM:

To evaluate the efficacy of tenofovir switch therapy in nucleos(t)ide-experienced patients, and identify the factors associated with treatment response of tenofovir switch therapy.

METHODS:

Nucleos(t)ide-experienced hepatitis B e antigen-positive and -negative patients prescribed with tenofovir were retrospectively identified and recruited for prospective analysis. Hepatitis B virus (HBV) DNA and other biochemical parameters were monitored in regular 3-6 monthly follow-up visits. Primary efficacy endpoint was maintained-virologic response with tenofovir switch therapy, defined as undetectable HBV DNA (<20 IU/mL) until the last follow-up visit.

RESULTS:

An overall of 214/252 (84.9%) patients achieved maintained-virologic response after 22 (7-55) months of tenofovir switch therapy. On multivariate analysis, a lower HBV DNA level at the time of switching to tenofovir was an independent factor associated with treatment efficacy. Maintained-virologic response after switching to tenofovir was achieved in 177/190 (93.2%) patients with HBV DNA <20 000 IU/mL vs. 37/62 (59.7%) patients with HBV DNA ≥20 000 IU/mL (P < 0.001). Absence of genotypic resistance to lamivudine or adefovir dipivoxil was not associated with improved treatment outcome.

CONCLUSIONS:

Tenofovir switch therapy is an effective treatment strategy in nucleos(t)ide-experienced chronic hepatitis B patients. However, in patients with HBV DNA ≥20 000 IU/mL at the time of switching to tenofovir, the chance of achieving maintained undetectable HBV DNA is significantly reduced.

• Authors: A O-S Lo, V W-S Wong, G L-H Wong, Y-K Tse, H-Y Chan, H L-Y Chan
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 41 Issue 11 Pg. 1190-9 (Jun 2015) ISSN: 1365-2036 [Electronic] England
• PMID: 25825194 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 John Wiley & Sons Ltd.

Chemical References

• Antiviral Agents
• Hepatitis B e Antigens
• Organophosphonates
• Lamivudine
• Tenofovir
• Adenine
• adefovir dipivoxil

Topics

• Adenine (analogs & derivatives, pharmacology, therapeutic use)
• Adult
• Antiviral Agents (therapeutic use)
• Female
• Hepatitis B e Antigens (immunology)
• Hepatitis B, Chronic (drug therapy)
• Humans
• Lamivudine (pharmacology)
• Male
• Middle Aged
• Organophosphonates (pharmacology, therapeutic use)
• Prospective Studies
• Tenofovir
• Treatment Outcome