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KMID : 1040620170230010066
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Clinical and Molecular Hepatology
2017 Volume.23 No. 1 p.66 ~ p.73
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Tenofovir has inferior efficacy in adefovir-experienced chronic hepatitis B patients compared to nucleos(t)ide-naive patients
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Chung Goh-Eun
Cho Eun-Ju
Lee Jeong-Hoon
Yoo Jeong-Ju
Lee Min-Jong
Cho Yu-Ri
Lee Dong-Hyeon
Kim Hwi-Young
Yu Su-Jong
Kim Yoon-Jun
Yoon Jung-Hwan
Zoulim Fabien
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Abstract
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Background/Aims: A recent study reported that entecavir had inferior efficacy in nucleos(t)ide analogue (NA)-experienced chronic hepatitis B (CHB) patients compared to NA-naive patients. We sought to compare the efficacy of tenofovir disoproxil fumarate (TDF) in NA-experienced and NA-naive CHB patients.
Methods: We retrospectively enrolled 252 consecutive patients who had a serum hepatitis B virus (HBV) DNA level greater than 2,000 IU/mL at the initiation of TDF treatment and who received TDF for at least 6 months. Complete virologic suppression (CVS) was defined as undetectable serum HBV DNA. We generated a multivariate Cox proportional-hazard model to examine predictive factors that were independently associated with time to CVS.
Results: The mean age of patients was 48.2 years, and the cohort included 181 NA-naive patients and 71 NA-experienced patients. The median duration of TDF treatment was 14.4 (interquartile range, 9.5-17.8) months. A total of 167 (92.3%) of 181 NA-naive patients achieved CVS, and 60 (84.5%) of 71 NA-exposed patients achieved CVS. Forty-nine (89.1%) of 55 patients who previously took an NA aside from adefovir and 11 (68.8%) of 16 adefovir-experienced patients achieved CVS. In multivariable analysis, previous adefovir exposure significantly influenced time to CVS (hazard ratio, 0.37; 95% confidence interval, 0.19-0.72; P=0.003), after adjusting for HBeAg positivity, baseline HBV DNA level and cirrhosis.
Conclusions: Tenofovir had inferior efficacy in adefovir-experienced CHB patients compared to NA-naive patients. The response of patients with previous adefovir exposure to TDF monotherapy should be monitored closely.
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KEYWORD
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Tenofovir, Adefovir, Hepatitis B
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