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Entecavir plus adefovir or entecavir plus tenofovir for patients with chronic hepatitis B resistant to neucleot(s)ide analogues
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Program Abstract:
Background & Aims: The consensus is little about the optimal management of patients with chronic hepatitis B (CHB) who developed drug resistance. Methods: We enrolled 258 patients with compensated CHB who developed nucleot(s)ide analogues resistant mutations during nucleot(s)ide analogues medication for 2years. Among these patients, 58 were treated with a combination of entecavir plus adefovir (ETV + ADV group) and 36 were treated with a combination of entecavir plus tenofovir (ETV + TDF group). Results: Baseline serum DNA level of ETV + ADV group tends to higher than ETV + TDF group. After adjustment by propensity score, the rate of complete virologic response (CVR, serum HBV DNA < 300 copies/mL) was significant greater in the ETV + ADV than in the ETV + TDF group in 12 months (39% vs. 67%, p = 0.018 at 3 months; 44% vs. 72%, p = 0.017 at 6 months; 47%vs.86%, p < 0.001 at 9 months; 56% vs. 89%, p = 0.002 at 12 months). The rate of CVR was significantly increased in ETV + TDF group (p = 0.009, HR = 2.177, CI = 1.210-3.917) and decreased in patients with high baseline serum DNA level. (p = 0.010, HR = 0.714, CI = 0.553-0.921) in multivariate analysis. Conclusions: In patients with CHB who developed drug resistance, combination therapy with ETV + TDF was superior to ETV + ADV in achieving CVR. We suggest more potent combination therapy was needed in patients who developed drug resistance. Further large-scale prospective study is needed for delineation of these results.
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