标题: Medication Nonadherence with Long-Term Management of Patients with Hepatitis B e [打印本页] 作者: StephenW 时间: 2011-2-21 22:13 标题: Medication Nonadherence with Long-Term Management of Patients with Hepatitis B e
Digestive Diseases and Sciences
DOI: 10.1007/s10620-011-1610-5Online First™
Original Article
Medication Nonadherence with Long-Term Management of Patients with Hepatitis B e
antigen-Negative Chronic Hepatitis B
Nghiem B. Ha, Nghi B. Ha, Ruel T. Garcia, Huy N. Trinh, Kevin T. Chaung, Huy A.
Nguyen, Khanh K. Nguyen, Brian S. Levitt and Mindie H. Nguyen
Abstract
Background and Aims
Antiviral treatment responses for patients with hepatitis B e antigen
(HBeAg)-negative chronic hepatitis B (CHB) are well-defined by data from
registration trials but may differ from patients seen in community settings
where medical adherence is usually not as strictly monitored. The goal of this
study was to examine the long-term outcomes of HBeAg-negative patients in a
community clinical setting.
Methods
We performed a cohort study of 189 consecutive treatment-naïve patients with
CHB who were treated with either entecavir (ETV) 0.5 mg daily (n = 107) or
adefovir dipivoxil (ADV) 10 mg daily (n = 82) from 2002 to 2009 at two community
clinics.
Results
All patients were Asians. Both ETV and ADV cohorts had similar median baseline
ALT and HBV DNA levels. By year 4, a similar proportion of ETV and ADV patients
who remained on monotherapy achieved complete viral suppression (91–96%);
however, more patients in the ADV cohort required alternative therapy (27 vs.
5%). No patients in the ETV cohort developed resistance while 18% of the ADV
cohort did. Cumulative nonadherence rates were 10 and 12% in ADV and ETV
cohorts, respectively.
Conclusions
Failure to monotherapy in a community clinical setting is due to both antiviral
resistance and patient nonadherence. Medication nonadherence is likely to be a
more important contributor to treatment failure than antiviral resistance,
especially with new anti-HBV agents such as ETV and tenofovir.