A Stanford University study presented at the Digestive Disease Week
conference found that the antiviral tenofovir (Viread) was more
effective than entecavir (Baraclude) at quickly reducing high viral
loads in HBeAg-positive patients.
However, both antivirals are equally effective in HBeAg-negative patients.
Both entecavir and tenofovir are highly-rated antivirals and both are recommended as first-line treatment for hepatitis B.
Researchers compared how long it took each
antiviral to completely suppress HBV DNA to undetectable levels (less
than 60 international units per milliliter – IU/mL) in patients whose
viral load exceeded 1 million IU/mL and who had never been treated
Sixty-two patients were treated with tenofovir and
199 patients were treated with entecavir. Both groups were fairly
similar in age, weight, gender, ALT levels and liver health.
Among HBeAg-negative patients, there was no significant difference in viral suppression rates between the two antivirals.
But among HBeAg-positive patients:
- 16% of those treated with tenofovir achieved
viral suppression within six months, compared to 11% of those treated
- After 12 months, 50% of tenofovir-treated
patients achieved undetectable HBV DNA compared to 31% of
- And after 18 months, 71% of tenofovir patients had undetectable viral compared to 39% of entecavir-treated patients.
“Tenofovir is significantly more effective than
entecavir for achieving complete viral suppression in HBeAg-positive,
treatment-naïve hepatitis B patients with HBV DNA (exceeding) 1 million
IU/mL,” they wrote. “Moreover, the difference between tenofovir and
entecavir becomes more and more pronounced with increasing treatment
time. In contrast, for HBeAg-negative patients, there is no significant
difference in rates of viral suppression between entecavir and
Source: “Tenofovir Is More Effective Than Entecavir…” by Linhyi, Huy et al. Digestive Disease Week, May 2013.
74% of Patients Get Rid of
Cirrhosis after 5 Years of
A Taiwanese study, published in the May issue of the Journal of Hepatology,
showed that tenofovir was able to get rid of cirrhosis in nearly
three-quarters of patients treated with the antiviral after five years.
In the study, 348 hepatitis B patients were
treated with tenofovir for 240 weeks. Liver biopsies, which had been
conducted at the start and end of treatment, showed that 87% had
improvements in liver health.
They reported that 51% had regression or reduced
fibrosis, and of the 96 with cirrhosis (severe liver scarring), they
found that 71 (74%) no longer had cirrhosis after 240 weeks.
“In patients with chronic HBV infection, up to 5
years of treatment with tenofovir was safe and effective,” researchers
wrote. “Long-term suppression of HBV can lead to regression of fibrosis
Source: “Reversal of Cirrhosis,” by Liaw YV. Hepatol. 2013 May.
Researchers Find Tenofovir Does Not Damage Kidneys
People chronically infected with HBV reportedly have
higher rates of mild kidney damage, and tenofovir has been linked to
kidney damage and reduced renal (kidney) function in HIV patients.
Researchers from the University of California San Francisco, Pacific
Health Foundation and Stanford monitored hepatitis B patients to see if
tenofovir caused kidney problems more so than the antiviral entecavir.
They followed two groups of 72 patients treated with either tenofovir or entecavir. The patient groups were similar in demographics.
Researchers found no significant difference in
changed renal function in the two groups. None of the patients
experienced any marked decreases in kidney function.
“Tenofovir treatment was not an independent
predictor for significant deterioration of renal function but older age
and baseline impaired renal function were,” researchers noted in their
presentation at the Digestive Disease Week conference. “Renal function
of HBV patients on antiviral therapy with either tenofovir or
entecavir should be monitored, especially in those who are older and/or
with known impaired renal function.”
Source: “Renal Function in CHB Patients Treated With Tenofovir…” by Ha, Ku et al. Digestive Disease Week, May 2013.
Tenofovir and Entecavir Highly Effective—If Taken as Prescribed
Researchers followed 845 patients treated with
antivirals over a 10-year The study, which lasted from 2001 to 2011,
followed 93 patients treated with lamivudine (Epivir-HBV), 198 with
adefovir (Hepsera), 447 with entecavir and 107 with tenofovir over 12
The majority of patients were Asian-Americans,
male and HBeAg-negative with an average age of 47. Viral loads were
similar among all participants. The percentage who achieved
undetectable viral load after 12 months of treatment varied
significantly between groups.
- 39% in the lamivudine group
- 54% in the adefovir group
- 75% in the entecavir group, and
- 81% in the tenofovir group.
The percentage of patients who had a resurgence
(viral breakthrough) in HBV DNA after 12 months of treatment was 2.5%
in the entecavir group and 8.6% in the tenofovir group. However, these
breakthroughs were due to failure to take the antiviral pills as
prescribed, according to the report presented at Digestive Disease
“Antiviral therapy with either entecavir or
tenofovir is highly effective in suppressing HBV viral replication, and
non-adherence is the primary cause of treatment failure, not viral
resistance, up to 8-9% after only 12 months,” researchers wrote.
Education stressing the importance of taking
medications as prescribed and close clinical monitoring are needed to
improve patient medication adherence, they added.
Source: “Effectiveness of Oral Antiviral Therapy …” by Nguyen, Huy et al.” Disease Week, May 2013
Christine Kukka, HBV Project Manager, HBV Advocate
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