Antiviral effect of entecavir in chronic hepatitis B: Influence of prior exposure to nucleos(t)ide analogues

March 10, 2010

J Hepatol. 2010 Feb 4. [Epub ahead of print]Antiviral effect of entecavir in

chronic hepatitis B: Influence of prior exposure to nucleos(t)ide

analogues.Reijnders JG, Deterding K, sen J, Zoulim F, Santantonio T, Buti

M, van Bömmel F, Hansen BE, Wedemeyer H, Janssen HL; for the VIRGIL Surveillance

Study Group.Department of Gastroenterology and Hepatology, Erasmus MC,

University Medical Center Rotterdam, Gravendijkwal 230, Room Ha 204, 3015 CE

Rotterdam, The Netherlands.BACKGROUND & AIMS: Entecavir is a potent inhibitor of

viral replication in nucleos(t)ide analogue (NA)-naïve chronic hepatitis B

patients, but data on the efficacy in NA-experienced subjects are limited.

METHODS: In a multi-center cohort study we investigated 161 chronic hepatitis B

patients (34% NA-experienced) treated with entecavir monotherapy. RESULTS:

During a median follow-up of 11 (3-23)months, 82 (79%) of 104 NA-naïve patients

achieved virologic response (VR), defined as HBV DNA <80IU/ml, and none of the

patients (0%) developed genotypic entecavir-resistance. VR was demonstrated in

31 (54%) of 57 NA-experienced patients during a median follow-up of 12

(3-31)months. Patients with lamivudine-resistant mutations at the start of

entecavir monotherapy had a reduced probability of achieving VR compared to

lamivudine-naïve patients (HR 0.14; 95% CI 0.04-0.58; p=0.007). Antiviral

efficacy was not decreased by prior treatment with lamivudine when

lamivudine-resistance had never developed (HR 0.81; 95% CI 0.43-1.52; p=0.52).

Prior adefovir therapy without development of adefovir-resistance (HR 0.84; 95%

CI 0.43-1.64; p=0.61) and presence of adefovir-resistance (HR 0.86; 95% CI

0.27-2.71; p=0.80) did not influence antiviral response to entecavir. Switching

to a tenofovir-containing treatment regimen resulted in viral load decline in

patients with entecavir-resistance associated mutations. CONCLUSIONS: Entecavir

proved to be efficacious in NA-naïve patients. The antiviral efficacy of

entecavir was not influenced by prior treatment with adefovir or presence of

adefovir-resistance. Entecavir should not be used in patients with previous

lamivudine-resistance, yet it may still be an option in lamivudine-experienced

patients in case lamivudine-resistance never developed.

European Association for the Study of the Liver. Published by Elsevier B.V. All

rights reserved.PMID: 20185191 [PubMed - as supplied by publisher]

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