Digestive Diseases and Sciences

, Volume 57, Issue 11, pp 3011–3016

Tenofovir Monotherapy and Tenofovir Plus Entecavir Combination as Rescue Therapy for Entecavir Partial Responders

  • Benjamin Yip
  • Kevin Chaung
  • Carrie R. Wong
  • Huy N. Trinh
  • Huy A. Nguyen
  • Aijaz Ahmed
  • Ramsey Cheung
  • Mindie H. Nguyen
Original Article

Abstract

Background and Aims

Despite high potency, a significant proportion of patients treated with entecavir achieve only partial viral suppression. Our goal was to examine the complete viral suppression rate (undetectable HBV DNA PCR levels) with alternative therapies in such patients.

Methods

We retrospectively studied 42 consecutive patients with partial response to entecavir (detectable HBV DNA at ≥12 months of therapy) who were treated at three clinics with rescue therapies: entecavir + adefovir (n = 5), tenofovir (n = 6), and entecavir + tenofovir (n = 31). Antiviral resistance was excluded by negative mutation analysis and/or absence of virologic breakthrough (increase >1 log10IU/mL from nadir).

Results

All patients were Asian and 57 % were male with a median age of 36 (22–64) years. Only a few patients had prior exposure to lamivudine (7 %) or adefovir (7 %). Almost all patients (95 %) had positive HBeAg. Overall, the complete viral suppression rate was 79 %, and the alanine aminotransferase normalization rate was 83 % in entecavir partial responders after 6 months on rescue therapies. Cumulative complete viral suppression rates were significantly different (P = 0.0164) among the entecavir + adefovir, tenofovir, and entecavir + tenofovir treatment groups at 6 months (20 vs. 83 vs. 83 %, respectively) and 12 months (20 vs. 100 vs. 97 %). All three patients without complete viral suppression on entecavir + adefovir became aviremic 6 months after switching to entecavir + tenofovir.

Conclusions

Virologic response to entecavir + tenofovir combination therapy and tenofovir monotherapy appeared to be similar in most patients, but not with the entecavir + adefovir combination.

Keywords

Combination therapy Suboptimal Nonresponse Virologic response Switch 

List of Abbreviations

ADV

Adefovir

CHB

Chronic hepatitis B

ETV

Entecavir

HBV

Hepatitis B virus

HCC

Hepatocellular carcinoma

HCV

Hepatitis C virus

HIV

Human immunodeficiency virus

LAM

Lamivudine

TDF

Tenofovir

ALT

Alanine aminotransferase

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Benjamin Yip
    • 1
  • Kevin Chaung
    • 2
  • Carrie R. Wong
    • 2
  • Huy N. Trinh
    • 2
    • 3
  • Huy A. Nguyen
    • 2
    • 3
  • Aijaz Ahmed
    • 1
  • Ramsey Cheung
    • 4
  • Mindie H. Nguyen
    • 1
  1. 1.Division of Gastroenterology and HepatologyStanford University Medical CenterPalo AltoUSA
  2. 2.Pacific Health FoundationSan JoseUSA
  3. 3.San Jose GastroenterologySan JoseUSA
  4. 4.VA Palo Alto Health Care SystemPalo AltoUSA

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