Tenofovir disoproxil fumarate (TDF) vs. emtricitabine (FTC)/TDF in lamivudine resistant hepatitis B: A 5-year randomised study

Scott Fung, Peter Kwan, Milotka Fabri, Andrzej Horban, Mijomir Pelemis, Hie Won Hann, Selim Gurel, Florin A. Caruntu, John F. Flaherty, Benedetta Massetto, Kyungpil Kim, Kathryn M. Kitrinos, G. Mani Subramanian, John G. McHutchison, Leland J. Yee, Magdy Elkhashab, Thomas Berg, Ioan Sporea, Cihan Yurdaydin, Petr HusaMaciej S. Jablkowski, Edward Gane

Research output: Contribution to journalArticlepeer-review

Abstract

Background & Aims Long-term treatment with tenofovir disoproxil fumarate (TDF) alone, or in combination with emtricitabine (FTC) is associated with sustained viral suppression in patients with lamivudine resistant (LAM-R) chronic hepatitis B (CHB). Methods LAM-R CHB patients were randomised 1:1 to receive TDF 300 mg or FTC 200 mg and TDF 300 mg once daily in a prospective, double blind, study. The proportion of patients with plasma hepatitis B virus (HBV) DNA <69 IU/ml (<400 copies/ml) at week 96 (primary efficacy endpoint) was reported previously. Here we present week 240 follow-up data. Results Overall, 280 patients were randomised to receive TDF (n = 141) or FTC/TDF (n = 139), and 85.4% completed 240 weeks of treatment. At week 240, 83.0% of patients in the TDF arm, and 82.7% of patients in the FTC/TDF treatment arm had HBV DNA <69 IU/ml (p = 0.96). Rates of normal alanine aminotransferase (ALT) and normalised ALT were similar between groups (p = 0.41 and p = 0.97 respectively). Hepatitis B e antigen loss and seroconversion at week 240 were similar between groups, (p = 0.41 and p = 0.67 respectively). Overall, six patients achieved hepatitis B surface antigen (HBsAg) loss and one patient (FTC/TDF arm) had HBsAg seroconversion by week 240. No TDF resistance was observed up to week 240. Treatment was generally well tolerated, and renal events were mild and infrequent (∼8.6%). The mean change in bone mineral density at week 240 was −0.98% and −2.54% at the spine and hip, respectively. Conclusions TDF monotherapy was effective and well tolerated in LAM-R CHB patients for up to 240 weeks. Lay summary The goal of oral antiviral treatment for chronic hepatitis B (CHB) is to achieve and maintain undetectable HBV DNA levels. Treatment options with enhanced potency, and low risk of resistance development for patients infected with lamivudine resistant (LAM-R) HBV are required. Tenofovir disoproxil fumarate (TDF) monotherapy was effective and well tolerated without TDF resistance development in CHB patients with LAM-R, for up to 240 weeks. Clinical trial number: NCT00737568.

Original languageEnglish (US)
Pages (from-to)11-18
Number of pages8
JournalJournal of Hepatology
Volume66
Issue number1
DOIs
StatePublished - Jan 1 2017

Keywords

  • Bone mineral density
  • Emtricitabine
  • Lamivudine resistant
  • Renal function
  • Tenofovir disoproxil fumarate
  • Viral suppression

ASJC Scopus subject areas

  • Hepatology

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