Entecavir (Baraclude) Works Well in Patients with Adefovir-resistant Hepatitis B, but Lamivudine Resistance Compromises Efficacy

[Guest guest]

http://www.hivandhepatitis.com/hep_b/news/2010/0402_2010_a.htmlEntecavir

(Baraclude) Works Well in Patients with Adefovir-resistant Hepatitis B, but

Lamivudine Resistance Compromises Efficacy    SUMMARY: The nucleoside analog

entecavir (Baraclude) worked well in previously untreated chronic hepatitis B

patients and in people who had developed resistance to the nucleotide analog

adefovir (Hepsera), but did not perform well in people with resistance to

lamivudine (Epivir-HBV) according to a European study described in the April

2010 Journal of Hepatology. Among patients who developed resistance to

entecavir, tenofovir (Viread) remained an effective option.   By Liz

HighleymanSeveral nucleoside and nucleotide analog drugs are effective against

hepatitis B virus (HBV), but when they are used alone the virus can quickly

develop resistance, thereby compromising long-term treatment success.Jurrien

Reijnders and fellow investigators with the VIRGIL Surveillance Study Group

evaluated initial or sequential monotherapy using entecavir in 161 chronic B

patients, 34% of whom had received previous nucleoside/nucleotide treatment.

Participants were followed for a median of about 1 year (range 3-31

months).Results Among the 104 nucleoside/nucleotide-naive participants 79%

achieved virological response (HBV DNA < 80 IU/mL). None of these patients

developed entecavir-resistant virus, according to genotypic testing. Among the

57 nucleoside/nucleotide-experienced patients, 54% achieved virological

response.  Patients who had HBV mutations conferring lamivudine resistance at

the start of entecavir monotherapy had a significantly reduced probability of

achieving virological response compared with lamivudine-naive patients (hazard

ratio

---

0.14, or a 86% reduction; P = 0.007).  Antiviral efficacy did not

decrease significantly, however, among lamivudine treated participants who did

not develop lamivudine-resistance mutations (HR 0.81; P = 0.52).  Prior use of

adefovir did not compromise virological response to entecavir, whether or not

adefovir resistance mutations emerged (HR 0.84 and 0.86, respectively). Among

patients who developed entecavir resistance mutations, switching to a

tenofovir-containing regimen led to virological response. " Entecavir proved to be

efficacious in [nucleoside/nucleotide]-naive patients, " the study authors

concluded. " 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, " they added.These findings indicate that people who develop

resistance to one nucleoside/nucleotide analog have a good chance of responding

to some other agents in the class, at least in the short term. But the standard

of care for chronic hepatitis B is shifting toward initial combination therapy,

which can slow or prevent emergence of resistance over the long term.Erasmus MC,

University Medical Center Rotterdam, Rotterdam, Netherlands; Medical School

Hannover, Hannover, Germany; University of Hamburg, Hamburg, Germany; Hotel Dieu

Hospital Lyon, Lyon, France; Clinic of Infectious Diseases, University of

Foggia, Foggia, Italy; Hospital Vall de Hebron, and Ciber-EHD, Barcelona, Spain;

Charité University Medical Center Berlin, Berlin, Germany.4/2/10ReferenceJG

Reijnders, K Deterding, J sen, and others (VIRGIL Surveillance Study

Group). Antiviral effect of entecavir in chronic hepatitis B: influence of prior

exposure to nucleos(t)ide analogues. Journal of Hepatology 52(4): 493-500

(Abstract). April 2010. 

[Guest guest]

http://www.hivandhepatitis.com/hep_b/news/2010/0402_2010_a.htmlEntecavir

(Baraclude) Works Well in Patients with Adefovir-resistant Hepatitis B, but

Lamivudine Resistance Compromises Efficacy    SUMMARY: The nucleoside analog

entecavir (Baraclude) worked well in previously untreated chronic hepatitis B

patients and in people who had developed resistance to the nucleotide analog

adefovir (Hepsera), but did not perform well in people with resistance to

lamivudine (Epivir-HBV) according to a European study described in the April

2010 Journal of Hepatology. Among patients who developed resistance to

entecavir, tenofovir (Viread) remained an effective option.   By Liz

HighleymanSeveral nucleoside and nucleotide analog drugs are effective against

hepatitis B virus (HBV), but when they are used alone the virus can quickly

develop resistance, thereby compromising long-term treatment success.Jurrien

Reijnders and fellow investigators with the VIRGIL Surveillance Study Group

evaluated initial or sequential monotherapy using entecavir in 161 chronic B

patients, 34% of whom had received previous nucleoside/nucleotide treatment.

Participants were followed for a median of about 1 year (range 3-31

months).Results Among the 104 nucleoside/nucleotide-naive participants 79%

achieved virological response (HBV DNA < 80 IU/mL). None of these patients

developed entecavir-resistant virus, according to genotypic testing. Among the

57 nucleoside/nucleotide-experienced patients, 54% achieved virological

response.  Patients who had HBV mutations conferring lamivudine resistance at

the start of entecavir monotherapy had a significantly reduced probability of

achieving virological response compared with lamivudine-naive patients (hazard

ratio

---

0.14, or a 86% reduction; P = 0.007).  Antiviral efficacy did not

decrease significantly, however, among lamivudine treated participants who did

not develop lamivudine-resistance mutations (HR 0.81; P = 0.52).  Prior use of

adefovir did not compromise virological response to entecavir, whether or not

adefovir resistance mutations emerged (HR 0.84 and 0.86, respectively). Among

patients who developed entecavir resistance mutations, switching to a

tenofovir-containing regimen led to virological response. " Entecavir proved to be

efficacious in [nucleoside/nucleotide]-naive patients, " the study authors

concluded. " 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, " they added.These findings indicate that people who develop

resistance to one nucleoside/nucleotide analog have a good chance of responding

to some other agents in the class, at least in the short term. But the standard

of care for chronic hepatitis B is shifting toward initial combination therapy,

which can slow or prevent emergence of resistance over the long term.Erasmus MC,

University Medical Center Rotterdam, Rotterdam, Netherlands; Medical School

Hannover, Hannover, Germany; University of Hamburg, Hamburg, Germany; Hotel Dieu

Hospital Lyon, Lyon, France; Clinic of Infectious Diseases, University of

Foggia, Foggia, Italy; Hospital Vall de Hebron, and Ciber-EHD, Barcelona, Spain;

Charité University Medical Center Berlin, Berlin, Germany.4/2/10ReferenceJG

Reijnders, K Deterding, J sen, and others (VIRGIL Surveillance Study

Group). Antiviral effect of entecavir in chronic hepatitis B: influence of prior

exposure to nucleos(t)ide analogues. Journal of Hepatology 52(4): 493-500

(Abstract). April 2010. 

[Guest guest]

http://www.hivandhepatitis.com/hep_b/news/2010/0402_2010_a.htmlEntecavir

(Baraclude) Works Well in Patients with Adefovir-resistant Hepatitis B, but

Lamivudine Resistance Compromises Efficacy    SUMMARY: The nucleoside analog

entecavir (Baraclude) worked well in previously untreated chronic hepatitis B

patients and in people who had developed resistance to the nucleotide analog

adefovir (Hepsera), but did not perform well in people with resistance to

lamivudine (Epivir-HBV) according to a European study described in the April

2010 Journal of Hepatology. Among patients who developed resistance to

entecavir, tenofovir (Viread) remained an effective option.   By Liz

HighleymanSeveral nucleoside and nucleotide analog drugs are effective against

hepatitis B virus (HBV), but when they are used alone the virus can quickly

develop resistance, thereby compromising long-term treatment success.Jurrien

Reijnders and fellow investigators with the VIRGIL Surveillance Study Group

evaluated initial or sequential monotherapy using entecavir in 161 chronic B

patients, 34% of whom had received previous nucleoside/nucleotide treatment.

Participants were followed for a median of about 1 year (range 3-31

months).Results Among the 104 nucleoside/nucleotide-naive participants 79%

achieved virological response (HBV DNA < 80 IU/mL). None of these patients

developed entecavir-resistant virus, according to genotypic testing. Among the

57 nucleoside/nucleotide-experienced patients, 54% achieved virological

response.  Patients who had HBV mutations conferring lamivudine resistance at

the start of entecavir monotherapy had a significantly reduced probability of

achieving virological response compared with lamivudine-naive patients (hazard

ratio

---

0.14, or a 86% reduction; P = 0.007).  Antiviral efficacy did not

decrease significantly, however, among lamivudine treated participants who did

not develop lamivudine-resistance mutations (HR 0.81; P = 0.52).  Prior use of

adefovir did not compromise virological response to entecavir, whether or not

adefovir resistance mutations emerged (HR 0.84 and 0.86, respectively). Among

patients who developed entecavir resistance mutations, switching to a

tenofovir-containing regimen led to virological response. " Entecavir proved to be

efficacious in [nucleoside/nucleotide]-naive patients, " the study authors

concluded. " 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, " they added.These findings indicate that people who develop

resistance to one nucleoside/nucleotide analog have a good chance of responding

to some other agents in the class, at least in the short term. But the standard

of care for chronic hepatitis B is shifting toward initial combination therapy,

which can slow or prevent emergence of resistance over the long term.Erasmus MC,

University Medical Center Rotterdam, Rotterdam, Netherlands; Medical School

Hannover, Hannover, Germany; University of Hamburg, Hamburg, Germany; Hotel Dieu

Hospital Lyon, Lyon, France; Clinic of Infectious Diseases, University of

Foggia, Foggia, Italy; Hospital Vall de Hebron, and Ciber-EHD, Barcelona, Spain;

Charité University Medical Center Berlin, Berlin, Germany.4/2/10ReferenceJG

Reijnders, K Deterding, J sen, and others (VIRGIL Surveillance Study

Group). Antiviral effect of entecavir in chronic hepatitis B: influence of prior

exposure to nucleos(t)ide analogues. Journal of Hepatology 52(4): 493-500

(Abstract). April 2010. 

[Guest guest]

http://www.hivandhepatitis.com/hep_b/news/2010/0402_2010_a.htmlEntecavir

(Baraclude) Works Well in Patients with Adefovir-resistant Hepatitis B, but

Lamivudine Resistance Compromises Efficacy    SUMMARY: The nucleoside analog

entecavir (Baraclude) worked well in previously untreated chronic hepatitis B

patients and in people who had developed resistance to the nucleotide analog

adefovir (Hepsera), but did not perform well in people with resistance to

lamivudine (Epivir-HBV) according to a European study described in the April

2010 Journal of Hepatology. Among patients who developed resistance to

entecavir, tenofovir (Viread) remained an effective option.   By Liz

HighleymanSeveral nucleoside and nucleotide analog drugs are effective against

hepatitis B virus (HBV), but when they are used alone the virus can quickly

develop resistance, thereby compromising long-term treatment success.Jurrien

Reijnders and fellow investigators with the VIRGIL Surveillance Study Group

evaluated initial or sequential monotherapy using entecavir in 161 chronic B

patients, 34% of whom had received previous nucleoside/nucleotide treatment.

Participants were followed for a median of about 1 year (range 3-31

months).Results Among the 104 nucleoside/nucleotide-naive participants 79%

achieved virological response (HBV DNA < 80 IU/mL). None of these patients

developed entecavir-resistant virus, according to genotypic testing. Among the

57 nucleoside/nucleotide-experienced patients, 54% achieved virological

response.  Patients who had HBV mutations conferring lamivudine resistance at

the start of entecavir monotherapy had a significantly reduced probability of

achieving virological response compared with lamivudine-naive patients (hazard

ratio

---

0.14, or a 86% reduction; P = 0.007).  Antiviral efficacy did not

decrease significantly, however, among lamivudine treated participants who did

not develop lamivudine-resistance mutations (HR 0.81; P = 0.52).  Prior use of

adefovir did not compromise virological response to entecavir, whether or not

adefovir resistance mutations emerged (HR 0.84 and 0.86, respectively). Among

patients who developed entecavir resistance mutations, switching to a

tenofovir-containing regimen led to virological response. " Entecavir proved to be

efficacious in [nucleoside/nucleotide]-naive patients, " the study authors

concluded. " 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, " they added.These findings indicate that people who develop

resistance to one nucleoside/nucleotide analog have a good chance of responding

to some other agents in the class, at least in the short term. But the standard

of care for chronic hepatitis B is shifting toward initial combination therapy,

which can slow or prevent emergence of resistance over the long term.Erasmus MC,

University Medical Center Rotterdam, Rotterdam, Netherlands; Medical School

Hannover, Hannover, Germany; University of Hamburg, Hamburg, Germany; Hotel Dieu

Hospital Lyon, Lyon, France; Clinic of Infectious Diseases, University of

Foggia, Foggia, Italy; Hospital Vall de Hebron, and Ciber-EHD, Barcelona, Spain;

Charité University Medical Center Berlin, Berlin, Germany.4/2/10ReferenceJG

Reijnders, K Deterding, J sen, and others (VIRGIL Surveillance Study

Group). Antiviral effect of entecavir in chronic hepatitis B: influence of prior

exposure to nucleos(t)ide analogues. Journal of Hepatology 52(4): 493-500

(Abstract). April 2010.