Prediction of virologic response to tenofovir mono-rescue therapy for multidrug resistant chronic hepatitis B

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• 作者：Sangheun Lee ; Jun Yong Park ; Do Young Kim ; Beom Kyung Kim ; Seung Up Kim ; Kijun Song ; Hye Jin Ku ; Kwang-Hyub Han and Sang Hoon Ahn
• 关键词：chronic hepatitis B ; tenofovir ; multidrug resistance ; virologic response
• 刊名：Journal of Medical Virology
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：88
• 期：6
• 页码：1027-1034
• 全文大小：322K
• ISSN：1096-9071

文摘

Most guidelines suggest combination therapy including nucleoside and nucleotide analogues for the treatment of chronic hepatitis B (CHB) with multidrug resistance (MD-R). However, long-term combination treatment can evoke high costs and safety problems. Therefore, we investigated the efficacy of tenofovir disoproxil fumarate (TDF) mono-rescue therapy for viral suppression in patients with CHB exhibiting MD-R. We reviewed patients with CHB exhibiting antiviral drug resistance treated by TDF mono-rescue therapy from December 2012 to June 2014. The patients were categorized into three groups: lamivudine-resistance (LAM-R) group (n = 290), and LAM-R + adefovir-resistance (ADV-R) group (n = 43), and LAM-R + entecavir-resistance (ETV-R) group (n = 113). We compared the virologic response rate according to the multiplicity of resistance and investigated the predictive factors of a virologic response. For a median of 15 months (range, 6–24 months) of TDF mono-rescue therapy, the cumulative virologic response rates were 82.8, 81.4, and 84.1% in the LAM-R, LAM-R + ADV-R, and LAM-R + ETV-R groups, respectively (P = 0.239). Multivariate analysis revealed that multiplicity of resistance did not influence the achievement of a virologic response (P = 0.218). However, the baseline HBV DNA level significantly influenced the achievement of a virologic response for the treatment of CHB with MD-R (P < 0.001). TDF mono-rescue therapy is an appropriate treatment for CHB with MD-R, and the baseline HBV DNA level is a significant predictive factor for a virologic response. These factors should be considered before treating CHB with MD-R. J. Med. Virol. 88:1027–1034, 2016.