Tenofovir-based rescue therapy for chronic hepatitis B patients who had failed treatment with lamivudine, adefovir, and entecavir.

Background and Aim In the past decade, many chronic hepatitis B ( CHB) patients have undergone sequential treatment with lamivudine ( LAM), adefovir ( ADV), and entecavir ( ETV) to manage antiviral resistance or insufficient suppression of HBV- DNA. Very limited data are available on the efficacy of tenofovir ( TDF) rescue regimens in patients with multidrug resistance ( MDR). Methods We investigated the antiviral efficacy of TDF/ LAM combination therapy versus TDF/ ETV combination therapy in 52 patients who failed three previous antiviral therapies. Results The study subjects were treated with TDF/ LAM combination therapy ( n = 25) or TDF/ ETV combination therapy ( n = 27) for more than six months. Virologic response ( VR) occurred in 39 (75%) patients (19 patients belonged to the TDF/ LAM group and 20 patients belonged to the TDF/ ETV group). The VR rates were not different between the TDF/ LAM and TDF/ ETV groups (56.0% vs 51.9% at month 12, and 72.0% vs 78.8% at month 18; log rank P = 0.515). In addition, treatment efficacy of TDF/ LAM combination or TDF/ ETV combination was not statistically different according to types of MDR. In multivariate analysis, absolute HBV- DNA level at the start of TDF rescue treatment ( P < 0.001; OR, 0.452; 95% CI, 0.306-0.666) was only significantly associated with VR. Conclusions TDF/ ETV combination therapy was not associated with higher rate of VR compared with TDF/ LAM combination therapy in MDR CHB patients. These results raise the suspicion about the superiority of the combination therapy over TDF monotherapy. The lower HBV- DNA levels at the start of TDF-based rescue therapy were associated with higher VR. [ABSTRACT FROM AUTHOR]