Monotherapy versus combination therapy for the treatment of chronic hepatitis B
- 11 August 2009
- journal article
- review article
- Published by Taylor & Francis Ltd in Expert Opinion on Investigational Drugs
- Vol. 18 (11), 1655-1666
- https://doi.org/10.1517/13543780903241599
Abstract
Background: Nucleos(t)ide analogues, active against hepatitis B polymerase, suppress viral replication and improve clinical outcome. However, the emergence of drug-resistant mutants can result in treatment failure. Objectives: We describe how the choice of first-line therapy is critical to long-term treatment success. Methods: A review of current drug therapies is provided. Results/conclusions: Monotherapy with early-generation drugs (lamivudine or adefovir) was associated with a high rate of viral drug resistance and combination therapy with these agents was shown to reduce the incidence of resistance. The latest-generation drugs (entecavir and tenofovir) are potent inhibitors of viral replication and, in treatment-naive subjects, viral resistance to entecavir is uncommon and is not yet reported to tenofovir. Therefore, monotherapy with either entecavir or tenofovir is the current preferred option in treatment-naive patients. Combination therapy is appropriate in those with drug-resistant HBV infection, where drug choice is guided by the viral drug-resistance genotype/phenotype. Although combination therapy has been advocated in other patient groups (e.g., those with decompensated cirrhosis and following liver transplantation), there are, as yet, no data to mandate the use of combination therapy in such patients and any perceived benefit must be weighed against increased cost and risk for toxicity.Keywords
This publication has 108 references indexed in Scilit:
- The Amount of Hepatocyte Turnover That Occurred during Resolution of Transient Hepadnavirus Infections Was Lower When Virus Replication Was Inhibited with EntecavirJournal of Virology, 2009
- Understanding the molecular basis of HBV drug resistance by molecular modelingAntiviral Research, 2008
- Complex dynamics of hepatitis B virus resistance to adefovirHepatology, 2008
- Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2008 updateHepatology International, 2008
- Evolution of Primary and Compensatory Lamivudine Resistance Mutations in Chronic Hepatitis B Virus-Infected Patients during Long-Term Lamivudine Treatment, Assessed by a Line Probe AssayJournal of Clinical Microbiology, 2007
- Predicting response to peginterferon -2a, lamivudine and the two combined for HBeAg-negative chronic hepatitis BGut, 2007
- Inhibition of Hepatitis B Virus Polymerase by EntecavirJournal of Virology, 2007
- In Vitro Study of the Effects of Precore and Lamivudine-Resistant Mutations on Hepatitis B Virus ReplicationJournal of Virology, 2007
- Emergence of a Novel Lamivudine-Resistant Hepatitis B Virus Variant with a Substitution Outside the YMDD MotifAntimicrobial Agents and Chemotherapy, 2006
- A prospective study of the evolution of lamivudine resistance mutations in patients with chronic hepatitis B treated with lamivudineJournal of Viral Hepatitis, 2006