Durability of the virological response after lamivudine discontinuation in lamivudine‐resistant patients with a complete virological response after lamivudine and adefovir combination therapy

Abstract

We investigated the durability of virological response after lamivudine (LAM) discontinuation in LAM-resistant chronic hepatitis B (CHB) patients with complete virological response after LAM-adefovir (ADV) combination therapy. We enrolled 58 patients switched to ADV monotherapy with undetectable viral loads (<12 IU/ml) and normal alanine aminotransferase levels after ADV add-on combination treatment for at least 6 months in LAM-resistant CHB patients. Virologic relapse was defined as HBV DNA detection at more than 20 IU/ml by quantitative polymerase chain reaction determined on two consecutive measurements. During median 40.9 months of follow-up (range 11.5-79.0 months), seven (12.1%) patients experienced virological relapse. The cumulative rate of virological relapse at 3 and 5 years was 5.5% and 22.4%, respectively. Two patients had elevated alanine aminotransferase during virological relapse. These seven patients with virological relapse had undetectable HBV DNA after switching to tenofovir therapy. In our study, switching to ADV monotherapy resulted in sustained HBV DNA suppression in 87.9% of the patients during median 40.9 months follow-up. This adapting step-down strategy, switching from combination therapy to monotherapy in virologically suppressed CHB patients with stable liver disease, may reduce the cost burden and the risk of potentially harmful effects of combination therapy. J. Med. Virol. 89:85-90, 2017. © 2016 Wiley Periodicals, Inc.

Tenofovir versus tenofovir plus entecavir for chronic hepatitis B with lamivudine resistance and entecavir resistance

“…A change in the regimen to TDF mono‐rescue therapy following TDF plus ETV combination therapy can be considered for MD‐R HBV (LAM‐R plus ETV‐R). We reported previously that ADV mono‐rescue therapy can be applied for LAM‐R HBV following use of LAM + ADV . In another study of ADV‐R, a shift from TDF plus ETV combination therapy to TDF mono‐rescue therapy resulted in maintenance of the virologic response .…”

“…We reported previously that ADV mono-rescue therapy can be applied for LAM-R HBV following use of LAM + ADV. 25,26 In another study of ADV-R, a shift from TDF plus ETV combination therapy to TDF monorescue therapy resulted in maintenance of the virologic response. 13 Shifting from TDF + ETV combination therapy to TDF mono-rescue therapy will become an important strategy for economic and safety reasons.…”

An observational study on long‐term renal outcome in patients with chronic hepatitis B treated with tenofovir disoproxil fumarate

“…This single-centre, observational study used patients' data from Severance Hospital Liver Disease Cohort Registry (SOLID CORE). 8,10,[22][23][24] Of a total 860 patients who were treated with TDF as an initial therapy for CHB in Severance Hospital, Seoul, Korea from May 2012 to December 2015, 640 consecutive treatmentnaïve patients who met inclusion criteria were analysed.…”

Switching from tenofovir and nucleoside analogue therapy to tenofovir monotherapy in virologically suppressed chronic hepatitis B patients with antiviral resistance

“…Thus, it is reasonable to check whether combination therapy is necessary and if there is any possibility of switching to monotherapy. Similarly, several studies have been done on step‐down therapy . Kim et al assessed the feasibility of switching to ADV monotherapy after achieving CVR by ADV+LAM combination therapy.…”

“…The patients were identified using the Severance Hospital Liver Disease Cohort Registry (SOLID CORE), which is an internal web‐based electronic medical records repository that includes CHB patients treated with antiviral therapy at Severance Hospital, Yonsei University College of Medicine, from August 2012 to June 2017.…”