High Rate of Complete Viral Suppression With Combination Therapy in Patients With Chronic Hepatitis B and Prior Treatment Failure

[Guest guest]

http://journals.lww.com/jcge/Abstract/2011/11000/High_Rate_of_Complete_Viral_Sup\

pression_With.15.aspxJournal of Clinical Gastroenterology:

November/December 2011 - Volume 45 - Issue 10 - p 900–905

doi: 10.1097/MCG.0b013e318224d64f

LIVER, PANCREAS AND BILIARY TRACT: Original Articles

High Rate of Complete Viral Suppression With Combination Therapy in Patients

With Chronic Hepatitis B and Prior Treatment Failure

Wong, R. BA*,†; Trinh, Huy N. MD*,‡; Yip, BA§; Nguyen, Huy

A. MD‡; , Ruel T. MD*,‡; Ahmed, Aijaz MD§; Keeffe, Emmet B. MD§;

Nguyen, Mindie H. MD, MAS§

Abstract

Background: Combination therapy for chronic hepatitis B virus (HBV) infection is

recommended for patients with antiviral resistance (AVR) or partial response

(PR) to earlier antiviral therapy; however, data on outcomes are limited.

Goals: To determine the rate of complete viral suppression (CVS) with

combination therapy and to compare CVS among different indications and treatment

regimens.

Methods: A cohort of 109 consecutive patients with chronic hepatitis B from 3

liver clinics in Northern California was retrospectively studied. All patients

started combination therapy between April 2004 and August 2009 for the following

indications: AVR (n=29), PR (n=60), or others (n=20). Combination treatments

included lamivudine (LAM), adefovir (ADV), telbivudine (LdT), entecavir (ETV),

tenofovir (TDF), and emtricitabine (FTC). CVS was defined as undetectable serum

HBV DNA <100 IU/mL.

Results: Among the patients, who were nearly all Asian (99%), 73% had ≥2 prior

treatments and 82% had treatment failure (AVR or PR). Median treatment duration

of combination therapy was 21 months (range, 6 to 50 mo). The majority (77%)

achieved CVS after 6 months of various combination regimens: 80% for ETV+TDF,

76% for TDF+LAM or FTC or LdT, 75% for ETV+ADV, and 69% for ADV+LAM or LdT

(P=0.86). After 6 months of therapy, CVS was observed in a similar proportion of

patients treated for PR and AVR (72% and 74%, respectively).

Conclusions: Although the majority of 109 treatment-experienced patients had

prior treatment failure, high rates of CVS were rapidly achieved and did not

significantly differ between indications of AVR and PR or between ETV-based and

TDF-based regimens.

[Guest guest]

http://journals.lww.com/jcge/Abstract/2011/11000/High_Rate_of_Complete_Viral_Sup\

pression_With.15.aspxJournal of Clinical Gastroenterology:

November/December 2011 - Volume 45 - Issue 10 - p 900–905

doi: 10.1097/MCG.0b013e318224d64f

LIVER, PANCREAS AND BILIARY TRACT: Original Articles

High Rate of Complete Viral Suppression With Combination Therapy in Patients

With Chronic Hepatitis B and Prior Treatment Failure

Wong, R. BA*,†; Trinh, Huy N. MD*,‡; Yip, BA§; Nguyen, Huy

A. MD‡; , Ruel T. MD*,‡; Ahmed, Aijaz MD§; Keeffe, Emmet B. MD§;

Nguyen, Mindie H. MD, MAS§

Abstract

Background: Combination therapy for chronic hepatitis B virus (HBV) infection is

recommended for patients with antiviral resistance (AVR) or partial response

(PR) to earlier antiviral therapy; however, data on outcomes are limited.

Goals: To determine the rate of complete viral suppression (CVS) with

combination therapy and to compare CVS among different indications and treatment

regimens.

Methods: A cohort of 109 consecutive patients with chronic hepatitis B from 3

liver clinics in Northern California was retrospectively studied. All patients

started combination therapy between April 2004 and August 2009 for the following

indications: AVR (n=29), PR (n=60), or others (n=20). Combination treatments

included lamivudine (LAM), adefovir (ADV), telbivudine (LdT), entecavir (ETV),

tenofovir (TDF), and emtricitabine (FTC). CVS was defined as undetectable serum

HBV DNA <100 IU/mL.

Results: Among the patients, who were nearly all Asian (99%), 73% had ≥2 prior

treatments and 82% had treatment failure (AVR or PR). Median treatment duration

of combination therapy was 21 months (range, 6 to 50 mo). The majority (77%)

achieved CVS after 6 months of various combination regimens: 80% for ETV+TDF,

76% for TDF+LAM or FTC or LdT, 75% for ETV+ADV, and 69% for ADV+LAM or LdT

(P=0.86). After 6 months of therapy, CVS was observed in a similar proportion of

patients treated for PR and AVR (72% and 74%, respectively).

Conclusions: Although the majority of 109 treatment-experienced patients had

prior treatment failure, high rates of CVS were rapidly achieved and did not

significantly differ between indications of AVR and PR or between ETV-based and

TDF-based regimens.