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.
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