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Patterns of managing chronic hepatitis B treatment-related drug resistance: a survey of physicians in Mainland China, South Korea, Taiwan, and Thailand

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Abstract

Purpose

The emergence of antiviral resistance can negate the benefits of antiviral therapy in patients with chronic hepatitis B (CHB). This study aimed to assess how physicians in Asia manage suspected antiviral resistance.

Methods

Randomly selected CHB-treating physicians in Mainland China, South Korea, Taiwan, and Thailand underwent a face-to-face interview. A standardized questionnaire was used to assess how physicians identify, monitor, and manage suspected resistance and its associated medical costs.

Results

We interviewed 575 physicians from January to May 2008. Most physicians preferred a “prevention-of-antiviral resistance” strategy over a “rescue-once-resistance-develops” strategy. Physicians had encountered lamivudine resistance most frequently (96–100% of respondents), followed by the resistance to adefovir (18–58%) and entecavir (3–7%). While physicians in South Korea and Taiwan have access to resistance testing, physicians in Mainland China and Thailand have limited access to resistance testing but rely on HBV DNA and alanine aminotransferase (ALT) tests to identify resistance. Once resistance is suspected, 60% of the physicians in Mainland China, South Korea, and Thailand monitored these patients quarterly and the remaining 40% opted for monthly follow-up. In comparison, 70% of the Taiwanese physicians monitored these patients monthly. The average total direct medical costs, excluding antiviral costs, to manage a patient during the first year after suspected resistance is identified ranged from USD $319 to USD $709.

Conclusions

Limited access to HBV resistance tests causes physicians in Asia to manage suspected resistance by various HBV DNA assays and ALT tests. This raises concerns that resistance may not be detected early enough to be rescued efficiently.

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References

  1. Chen G, Lin W, Shen FM, IIoeje UH, London T, Evans AA. Chronic hepatitis B virus infection and mortality from non-liver causes: results from the Haimen City cohort study. Int J Epidemiol 2005;34:132–137

    Article  PubMed  Google Scholar 

  2. Chen CJ, Yang HI, Su J, Jen CL, You SL, Lu SN, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA 2006;295:65–73

    Article  PubMed  CAS  Google Scholar 

  3. Iloeje UH, Yang HY, Su J, Jen CL, You SL, Chen CJ. Predicting cirrhosis risk based on the level of circulating hepatitis B viral load. Gastroenterology 2006;30:678–686

    Article  Google Scholar 

  4. Lok AS, McMahon BJ. AASLD practice guidelines on chronic hepatitis B. Hepatology 2007;45:507–539

    Article  PubMed  CAS  Google Scholar 

  5. Liaw YF, Sung JJY, Chow WC, Farrell G, Lee CZ, Yuen H, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 2004;351:1521–1531

    Article  PubMed  CAS  Google Scholar 

  6. Keeffe EB, Dieterich DT, Han SB, Jacobson IM, Martin P, Schiff ER, et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: 2008 update. Clin Gastroenterol Hepatol 2008;6:1315–1341

    Article  PubMed  CAS  Google Scholar 

  7. Leung N. Recent data on treatment of chronic hepatitis B with nucleos(t)ide analogues. Hepatol Int 2008;2:163–178

    Article  Google Scholar 

  8. Liaw YF, Leung N, Kao JH, Piratvisuth T, Gane E, Han KH, et al. Asia-Pacific consensus statement on the management of chronic hepatitis B: a 2008 update. Hepatol Int 2008;2:263–283

    Article  Google Scholar 

  9. Lok AS, Zoulim F, Locarnini S, Bartholomeusz A, Ghany MG, Pawlotsky JM, et al. Antiviral drug-resistant HBV: standardization of nomenclature and assays and recommendations for management. Hepatology 2007;46:254–265

    Article  PubMed  CAS  Google Scholar 

  10. European Association for the Study of the Liver. EASL clinical practice guidelines: management of chronic hepatitis B. J Hepatol 2009;50:227–242

    Article  PubMed  CAS  Google Scholar 

  11. Lampertico P, Vigano M, Manenti E, Iavarone M, Lunghi G, Colombo M. Adefovir rapidly suppresses hepatitis B in HBeAg-negative patients developing genotypic resistance to lamivudine. Hepatology 2005;42:1414–1419

    Article  PubMed  CAS  Google Scholar 

  12. Locarnini S. Primary resistance, multidrug resistance, and cross-resistance pathways in HBV as a consequence of treatment failure. Hepatol Int 2008;2:147–151

    Article  Google Scholar 

  13. Pawlotsky JM, Dusheis G, Hatzakis A, Lau D, Lau G, Liang TJ, et al. Virologic monitoring of hepatitis B virus therapy in clinical trials and practice: recommendations for a standardized approach. Gastroenterology 2008;134:405–415

    Article  PubMed  Google Scholar 

  14. Li SC, Ong SC, Lim SG, Yeoh KG, Kwong KS, Lee V, et al. A cost comparison of management of chronic hepatitis B and its associated complications in Hong Kong and Singapore. J Clin Gastroenterol 2004;38(Suppl 3):S136–S143

    Article  PubMed  Google Scholar 

  15. Hsieh CR, Kuo CW. Cost of chronic hepatitis B virus infection in Taiwan. J Clin Gastroenterol 2004;38(Suppl 3):S148–S152

    Article  PubMed  Google Scholar 

  16. Guan ZQ, Dong ZH, Wang QH, Cao DX, Fang YY, Liu HT, et al. Cost of chronic hepatitis B infection in Mainland China. J Clin Gastroenterol 2004;38(Suppl 3):S175–S178

    Google Scholar 

  17. Yang BM, Kim CH, Kim JY. Cost of chronic hepatitis B infection in South Korea. J Clin Gastroenterol 2004;38(Suppl 3):S153–S157

    Article  PubMed  Google Scholar 

  18. Lesmana LA, Leung NWY, Mahachai V, Phiet PH, Suh DJ, Yao GB, et al. Hepatitis B: overview of the burden of disease in the Asia-Pacific region. Liver Int 2006;26:3–10

    Article  Google Scholar 

  19. Tafesse E, Claxton A, Granger A, Sanders J, Apelian D, Atillasoy E, et al. Estimates of health care costs for lamivudine-refractory chronic hepatitis B (CHB) patients. In Proceedings of the ISPOR 10th annual international meeting; 15–18 May 2005; Washington, DC

Download references

Acknowledgments

The authors thank Doctors Anna Lok, Bruce Kreter, Helena Brett-Smith, Suzy Ren, Iris Bian, Hyejin Hwang, Wonjoo Jung, Jennifer Lin, Alice Chen, Eric Lin, Atithep Mooreangratana, Ricardo Tamez, Simon Jones, Brenda Lau, Amy Chai, and Julie Newman for their review of the questionnaire and assistance in the project and the manuscript. In addition, the authors express their gratitude to the 575 physicians who participated in this survey. The fund for the study was provided by Bristol-Myers Squibb Company.

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Authors and Affiliations

  1. Department of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok-noi, Bangkok, 10700, Thailand

    Siwaporn Chainuvati

  2. Beijing Ditan Hospital, No 8, Shundong Jie, Chaoyang District, Beijing, 100015, China

    Jun Cheng

  3. Hepatology Unit and Department of Infectious Diseases, Institute of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China

    Jin Lin Hou

  4. Liver Research Unit, Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 199, Tung-Hwa North Road, Taipei, Taiwan

    Chao Wei Hsu

  5. Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Beijing, 100050, China

    Ji Dong Jia

  6. Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand

    Piyawat Komolmit

  7. Department of Internal Medicine, Konkuk University School of Medicine, 1 Hwayang-dong, Gwangjin-gu, Seoul, 143-701, Korea

    So Young Kwon & Chang Hong Lee

  8. Global Development and Medical Affairs, Asia Pacific, Bristol-Myers Squibb Company, 66 East Coast Road, Singapore, 428778, Singapore

    Hong Li, Ying Li & Boon Leong Neo

  9. Graduate Institute of Clinical Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei, 100, Taiwan

    Chun Jen Liu

  10. Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, 2 Yuh-Der Road, Taichung, 404, Taiwan

    Cheng Yuan Peng

  11. Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Arun-amarin Road, Bangkok, 10700, Thailand

    Tawesak Tanwandee

  12. Bristol-Myers Squibb, Thai, Ltd, 388 Exchange Tower, Floor 14, Sukhumvit Road, Klongtoey, Bangkok, 10110, Thailand

    Suchat Wongcharatrawee

  13. Department of Medical Research and Education, Taipei Veterans General Hospital, Institute of Clinical Medicine, National Yang-Ming University School of Medicine, 322 Shi-Pai Road, Sec. 2, Taipei, Taiwan

    Jaw Ching Wu

  14. Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Ming Lung Yu

  15. Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, No. 100 Tzyou 1st Road, Kaohsiung, 807, Taiwan

    Ming Lung Yu

  16. Department of Infectious Diseases, Rui Jin Hospital, 197 Rui Jin Er Road, Shanghai, 200025, China

    Xin Xin Zhang

Authors
  1. Siwaporn Chainuvati
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  2. Jun Cheng
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  3. Jin Lin Hou
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  4. Chao Wei Hsu
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  5. Ji Dong Jia
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  6. Piyawat Komolmit
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  7. So Young Kwon
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  8. Chang Hong Lee
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  9. Hong Li
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  10. Ying Li
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  11. Chun Jen Liu
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  12. Boon Leong Neo
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  13. Cheng Yuan Peng
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  14. Tawesak Tanwandee
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  15. Suchat Wongcharatrawee
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  16. Jaw Ching Wu
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  17. Ming Lung Yu
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  18. Xin Xin Zhang
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Corresponding author

Correspondence to Hong Li.

Additional information

Authors contributed equally to the conception and preparation of the manuscript and are listed alphabetically by their last names.

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Chainuvati, S., Cheng, J., Hou, J.L. et al. Patterns of managing chronic hepatitis B treatment-related drug resistance: a survey of physicians in Mainland China, South Korea, Taiwan, and Thailand. Hepatol Int 3, 453–460 (2009). https://doi.org/10.1007/s12072-009-9139-9

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  • DOI: https://doi.org/10.1007/s12072-009-9139-9

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