Source *Pacific Health Foundation ‡San Jose Gastroenterology, San Jose §Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, CA †Stony Brook University School of Medicine, Stony Brook, NY.
BACKGROUND: Combination therapy for chronic hepatitis B virus (HBV) infection is recommended for patients with antiviral resistance (AVR) or partial response (PR) to earlier antiviral therapy; however, data on outcomes are limited.
GOALS: To determine the rate of complete viral suppression (CVS) with combination therapy and to compare CVS among different indications and treatment regimens.
METHODS: A cohort of 109 consecutive patients with chronic hepatitis B from 3 liver clinics in Northern California was retrospectively studied. All patients started combination therapy between April 2004 and August 2009 for the following indications: AVR (n=29), PR (n=60), or others (n=20). Combination treatments included lamivudine (LAM), adefovir (ADV), telbivudine (LdT), entecavir (ETV), tenofovir (TDF), and emtricitabine (FTC). CVS was defined as undetectable serum HBV DNA <100 IU/mL.
RESULTS: Among the patients, who were nearly all Asian (99%), 73% had ≥2 prior treatments and 82% had treatment failure (AVR or PR). Median treatment duration of combination therapy was 21 months (range, 6 to 50 mo). The majority (77%) achieved CVS after 6 months of various combination regimens: 80% for ETV+TDF, 76% for TDF+LAM or FTC or LdT, 75% for ETV+ADV, and 69% for ADV+LAM or LdT (P=0.86). After 6 months of therapy, CVS was observed in a similar proportion of patients treated for PR and AVR (72% and 74%, respectively).
CONCLUSIONS: Although the majority of 109 treatment-experienced patients had prior treatment failure, high rates of CVS were rapidly achieved and did not significantly differ between indications of AVR and PR or between ETV-based and TDF-based regimens.