Issue
Volume 41, Issue 11, pages 1190–1199, June 2015
Article has an altmetric score of 4
1 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
2 Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
3 State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
* Correspondence to:
Prof. H. L.-Y. Chan, Department of Medicine and Therapeutics, 9/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong.
E-mail: [email protected]
This article was accepted for publication after full peer-review.
Summary
Background
Tenofovir disoproxil fumarate has been used in chronic hepatitis B patients with suboptimal virologic response to nucleos(t)ide analogues. The efficacy of tenofovir switch therapy has not been well studied in Asian patients.
Aim
To evaluate the efficacy of tenofovir switch therapy in nucleos(t)ide-experienced patients, and identify the factors associated with treatment response of tenofovir switch therapy.
Methods
Nucleos(t)ide-experienced hepatitis B e antigen-positive and -negative patients prescribed with tenofovir were retrospectively identified and recruited for prospective analysis. Hepatitis B virus (HBV) DNA and other biochemical parameters were monitored in regular 3–6 monthly follow-up visits. Primary efficacy endpoint was maintained-virologic response with tenofovir switch therapy, defined as undetectable HBV DNA (<20 IU/mL) until the last follow-up visit.
Results
An overall of 214/252 (84.9%) patients achieved maintained-virologic response after 22 (7–55) months of tenofovir switch therapy. On multivariate analysis, a lower HBV DNA level at the time of switching to tenofovir was an independent factor associated with treatment efficacy. Maintained-virologic response after switching to tenofovir was achieved in 177/190 (93.2%) patients with HBV DNA <20 000 IU/mL vs. 37/62 (59.7%) patients with HBV DNA ≥20 000 IU/mL (P < 0.001). Absence of genotypic resistance to lamivudine or adefovir dipivoxil was not associated with improved treatment outcome.
Conclusions
Tenofovir switch therapy is an effective treatment strategy in nucleos(t)ide-experienced chronic hepatitis B patients. However, in patients with HBV DNA ≥20 000 IU/mL at the time of switching to tenofovir, the chance of achieving maintained undetectable HBV DNA is significantly reduced.
规定与替诺福韦核苷（酸）IDE-经历乙型肝炎e抗原阳性和阴性的患者进行回顾性确定和招募的前瞻性分析。乙型肝炎病毒（HBV）DNA和其他生化指标在每月定期随访3-6进行了监测。主要疗效终点是替诺福韦治疗开关保持-病毒学应答，定义为检测不到HBV DNA（<20 IU / mL）中，直到最后随访。
结果
的二百五十二分之二百一十四（84.9％）患者的整体实现后，替诺福韦治疗开关22（7-55）个月保持-病毒学应答。多变量分析显示，在切换到替诺福韦的时间较低的HBV DNA水平与疗效相关的独立因素。切换到替诺福韦后保持-病毒学应答是在一百九十零分之一百七十七（93.2％）的患者实现了与HBV DNA <20 000 IU / mL相对62分之37（59.7％）患者的HBV DNA≥20000 IU /毫升（P < 0.001）。拉米夫定或阿德福韦酯基因型耐药的缺席是不是与改善治疗结果有关。
结论