Clin Mol Hepatol.  2020 Jul;26(3):352-363. 10.3350/cmh.2019.0044n.

Entecavir+tenofovir vs. lamivudine/telbivudine+adefovir in chronic hepatitis B patients with prior suboptimal response

Affiliations
  • 1Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea
  • 2Medical Research Institute, Pusan National University Hospital, Busan, Korea
  • 3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 4Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 5Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea
  • 6Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
  • 7Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
  • 8Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, Korea
  • 9Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University College of Medicine, Chonju, Korea

Abstract

Background/Aims
Suboptimal responses to lamivudine or telbivudine plus adefovir (LAM/LdT+ADV) rescue therapy are common in patients with LAM-resistant hepatitis B virus (HBV) infections. We compared patients switched to entecavir plus tenofovir (ETV+TDF) to those maintained on LAM/LdT+ADV.
Methods
This prospective randomized controlled trial examined 91 patients whose serum HBV DNA levels were greater than 60 IU/mL after at least 24 weeks of treatment with LAM/LdT+ADV for LAM-resistant HBV. Patients were randomized to receive a new treatment (ETV+TDF, n=45) or maintained on the same treatment (LAM/LdT+ADV, n=46) for 48 weeks. Patients with baseline ADV resistance were excluded.
Results
Compared to LAM/LdT+ADV group, ETV+TDF group had more patients with a virologic response (42/45 [93.33%] vs. 3/46 [6.52%], P<0.001) and had a greater mean reduction in serum HBV DNA level from baseline (-4.16 vs. -0.37 log10 IU/mL, P<0.001). Multivariate analysis indicated that high baseline HBV DNA level (P=0.005) and LAM/LdT+ADV maintenance therapy (P=0.001) were negatively associated with virologic response. At week 48, additional ADV- or ETV-associated mutations were cleared in ETV+TDF group, but such mutations were present in 4.3% of patients in LAM/LdT+ADV group (P=0.106). The two groups had similar rates of adverse events.
Conclusions
ETV+TDF combination treatment led to a significantly higher rate of virologic response compared to LAM/LdT+ADV combination treatment in patients with LAM-resistant HBV who had suboptimal responses to LAM/LdT+ADV regardless of HBV genotypic resistance profile (NCT01597934).

Keyword

Entecavir; Tenofovir; Lamivudine; Antiviral drug resistance; Adefovir
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