Switching to Tenofovir vs Continuing Entecavir in Chronic Hepatitis B

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Investigators examined the efficacy of switching to tenofovir with continuing entecavir in chronic hepatitis B virus.

Switching to tenofovir disoproxil fumarate (TDF) is more efficacious than continuing entecavir (ETV) for achieving an optimal response in patients with chronic hepatitis B with a partial virologic response to ETV, according to a multicenter, open-label, randomized controlled study published in the Journal of Viral Hepatitis.

Chronic hepatitis B can progress to liver cirrhosis, hepatic failure, and hepatocellular carcinoma; therefore, the long-term treatment goal is to prevent progression through control of viral replication.

Korean guidelines suggest either that patients undergoing treatment with a drug with a high genetic barrier be switched to another drug with a high genetic barrier or that monotherapy be continued and the patient monitored for a virologic response at 3- to 6-month intervals.

No studies have directly compared the efficacy of switching from ETV to TDF with that of continuing ETV; therefore, researchers prospectively compared the efficacy of switching to TDF in 22 patients with chronic hepatitis B who had been receiving 0.5 mg ETV for more than 12 months but who still had detectable hepatitis B virus (HBV) DNA levels >60 IU/mL with 23 patients who continued treatment with ETV.

The researchers found that the virologic response rate (HBV DNA <20 IU/mL) was significantly higher in the TDF group than in the ETV group (55% vs 20%, respectively; P=.022) after 12 months of treatment. In addition, the reduction in HBV DNA was greater (−1.13 vs −0.67 log10 IU/mL; P =.024), and the mean HBV DNA was lower (1.54 vs 2.01 log10 IU/mL; P =.011), in the TDF group than in the ETV group.

“In conclusion, to achieve optimal response in [chronic hepatitis B] patients with [partial virologic response] to ETV, switching to TDF would be a better strategy” stated the authors, adding, “Appropriate modification of therapy would further improve the outcome of chronic HBV infection.”


This study was supported by Gilead Sciences.

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Yim HJ, Kim IH, Suh SJ, et al. Switching to tenofovir vs continuing entecavir for HBV with partial virologic response to entecavir: a randomized controlled trial [published online May 17, 2018]. J Viral Hepat. doi: 10.1111/jvh.12934