Switching patients with lamivudine resistant chronic hepatitis B virus from tenofovir to adefovir re

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J Viral Hepat. 2008 Feb;15(2):108-14.

Switching patients with lamivudine resistant chronic hepatitis B virus from

tenofovir to adefovir results in less potent HBV-DNA suppression.

Leemans WF, Janssen HL, Niesters HG, de Man RA.

Department of Gastroenterology & Hepatology, Erasmus MC, University Medical

Center Rotterdam, Rotterdam, The Netherlands.

The nucleotide analogues, tenofovir disoproxil fumarate and adefovir dipivoxil,

inhibit viral replication and are both effective against the hepatitis B virus

(HBV). In our department, tenofovir was prescribed in addition to lamivudine for

the treatment of lamivudine resistant chronic hepatitis B. After registration of

adefovir, 10 patients were switched to adefovir monotherapy. We studied changes

in HBV-DNA and alanine aminotransferase (ALT) in these patients. The median

treatment duration with tenofovir was 78 weeks resulting in a median viral load

reduction of 5.4 (range 6.8-2.3) log(10) copies/mL compared to baseline (P =

0.005). Two patients had an increase>1 log(10) copies/mL during tenofovir

treatment. After the switch to adefovir, six out of 10 patients had an HBV-DNA>4

log(10) copies/mL and the median HBV-DNA increased from 2.8 to 4.5 log(10)

copies/mL (P = 0.017). The factors associated with relapse were HBV-DNA PCR

positivity at the time of switch and genotype B or D. ALT levels at the

beginning of tenofovir treatment also might be a factor. Retreatment with

tenofovir (n = 3) resulted in a rapid decline in HBV-DNA. Tenofovir is a potent

antiviral drug. Switching to adefovir resulted in viral relapse in 60% of

patients and retreatment with tenofovir resulted again in viral decline, which

suggests that tenofovir is a more potent antiviral agent.

PMID: 18184193 [PubMed - in process]

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