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Comparable efficacy with entecavir monotherapy and tenofovir–entecavir combination in chronic hepatitis B patients

OBJECTIVES: The long-term goal for chronic hepatitis B patients is to maintain viral suppression in order to reduce disease progression risk. Because patients with previous treatment failure may have multiple viral resistance mutations, finding effective therapy is challenging. Because recent studie...

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Autores principales: Baqai, Sumbella, Proudfoot, James, Xu, Ronghui, Kane, Steve, Clark, Margaret, Gish, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599168/
https://www.ncbi.nlm.nih.gov/pubmed/26462281
http://dx.doi.org/10.1136/bmjgast-2015-000030
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author Baqai, Sumbella
Proudfoot, James
Xu, Ronghui
Kane, Steve
Clark, Margaret
Gish, Robert
author_facet Baqai, Sumbella
Proudfoot, James
Xu, Ronghui
Kane, Steve
Clark, Margaret
Gish, Robert
author_sort Baqai, Sumbella
collection PubMed
description OBJECTIVES: The long-term goal for chronic hepatitis B patients is to maintain viral suppression in order to reduce disease progression risk. Because patients with previous treatment failure may have multiple viral resistance mutations, finding effective therapy is challenging. Because recent studies have shown that the combination of entecavir and tenofovir is effective in achieving virological response in many patients with prior treatment failure and multiple drug resistance mutations, we compared outcomes with this combination versus monotherapy. METHODS: With a retrospective chart review we compared results in 35 patients with previous treatment failure treated with the entecavir-tenofovir combination to results in patients treated with entecavir monotherapy. RESULTS: Although combination therapy resulted in significantly faster achievement of DNA negativity compared to entecavir monotherapy, the modest ten-week advantage is unlikely to be important for most patients since entecavir resistance develops extremely slowly. Significantly more patients on combination therapy experienced viral breakthroughs, most of which were attributed to non-adherence due to difficulties with the combination regimen. CONCLUSIONS: Our findings of reasonably comparable efficacy over time in the combination and monotherapy arms combined with the increased costs and compliance issues related to combination therapy weigh in favor of entecavir monotherapy in patients with previous treatment failure. However, because our study was a retrospective analysis of a small patient population, it will be important to confirm these findings with a randomised, controlled trial that compares these treatment approaches in treatment-experienced patients.
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spelling pubmed-45991682015-10-12 Comparable efficacy with entecavir monotherapy and tenofovir–entecavir combination in chronic hepatitis B patients Baqai, Sumbella Proudfoot, James Xu, Ronghui Kane, Steve Clark, Margaret Gish, Robert BMJ Open Gastroenterol Hepatology OBJECTIVES: The long-term goal for chronic hepatitis B patients is to maintain viral suppression in order to reduce disease progression risk. Because patients with previous treatment failure may have multiple viral resistance mutations, finding effective therapy is challenging. Because recent studies have shown that the combination of entecavir and tenofovir is effective in achieving virological response in many patients with prior treatment failure and multiple drug resistance mutations, we compared outcomes with this combination versus monotherapy. METHODS: With a retrospective chart review we compared results in 35 patients with previous treatment failure treated with the entecavir-tenofovir combination to results in patients treated with entecavir monotherapy. RESULTS: Although combination therapy resulted in significantly faster achievement of DNA negativity compared to entecavir monotherapy, the modest ten-week advantage is unlikely to be important for most patients since entecavir resistance develops extremely slowly. Significantly more patients on combination therapy experienced viral breakthroughs, most of which were attributed to non-adherence due to difficulties with the combination regimen. CONCLUSIONS: Our findings of reasonably comparable efficacy over time in the combination and monotherapy arms combined with the increased costs and compliance issues related to combination therapy weigh in favor of entecavir monotherapy in patients with previous treatment failure. However, because our study was a retrospective analysis of a small patient population, it will be important to confirm these findings with a randomised, controlled trial that compares these treatment approaches in treatment-experienced patients. BMJ Publishing Group 2015-06-08 /pmc/articles/PMC4599168/ /pubmed/26462281 http://dx.doi.org/10.1136/bmjgast-2015-000030 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Hepatology
Baqai, Sumbella
Proudfoot, James
Xu, Ronghui
Kane, Steve
Clark, Margaret
Gish, Robert
Comparable efficacy with entecavir monotherapy and tenofovir–entecavir combination in chronic hepatitis B patients
title Comparable efficacy with entecavir monotherapy and tenofovir–entecavir combination in chronic hepatitis B patients
title_full Comparable efficacy with entecavir monotherapy and tenofovir–entecavir combination in chronic hepatitis B patients
title_fullStr Comparable efficacy with entecavir monotherapy and tenofovir–entecavir combination in chronic hepatitis B patients
title_full_unstemmed Comparable efficacy with entecavir monotherapy and tenofovir–entecavir combination in chronic hepatitis B patients
title_short Comparable efficacy with entecavir monotherapy and tenofovir–entecavir combination in chronic hepatitis B patients
title_sort comparable efficacy with entecavir monotherapy and tenofovir–entecavir combination in chronic hepatitis b patients
topic Hepatology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599168/
https://www.ncbi.nlm.nih.gov/pubmed/26462281
http://dx.doi.org/10.1136/bmjgast-2015-000030
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