S-138 Comparison of tenofovir rescue therapy between single and multi-drug resistant chronic hepatitis B = S-138 Comparison of tenofovir rescue therapy between single and multi-drug resistant chronic hepatitis B

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Background:?Tenofovir (TDF) therapy has been recommended as a rescue strategy for chronic hepatitis B (CHB) patients with nucleos(t)ide (NA) resistance. Unfortunately, after sequential NA monotherapy in CHB patients with lamivudine (LAM) resistance, multidrug resistance (MDR) developed in a substantial number of patients. Very limited data are available on the comparison of TDF therapy between single drug resistant (SDR) and MDR groups in NA-resistant chronic hepatitis B patients.?Methods:?Of the 269 CHB patients with NA-resistance, 139 were SDR group and 130 were MDR group. A matched study population was constructed to compare the antiviral efficacy of TDF therapy by a propensity score analysis. The primary endpoint was a virological response (VR), defined as an HBV DNA level of ＜12 IU/mL.?Results:?Two hundreds CHB patients were selected after matching propensity score with 1:1 ratio. The median follow-up period during TDF therapy was 31.0 months (range, 6-44 months). VR occurred in 176 patients (92 patients in the SDR group and 84 patients in the MDR group) during the treatment period. The VR rates were not different between the SDR and MDR groups (84.5% vs. 75.4% at month 12, and 91.6% vs. 85.2% at month 24; log rank p＝0.085). PVR rates also were not differ between both groups (29.0% and 36.0% in the SDR and MDR groups, respectively; p＝0.291). ALT normalization rates did not differ between both groups. During TDF therapy, 7.8% (6 of 77) of patients in the SDR group, and 12.3% (10 of 81) of patients in the MDR group achieved HBeAg seroconversion, respectively (p＝0.343). In multivariate analysis, absolute HBV DNA level at the start of TDF rescue treatment (p＜0.001; OR, 0.708; 95% CI, 0.637-0.788) was only significantly associated with VR.?Conclusions:?TDF rescue therapy has comparable efficacy in the SDR and MDR CHB patients, and the presence of MDR did not alter the response rates. HBV DNA level at the start of TDF rescue therapy was the only predictor of subsequent virologic response. Therefore, starting rescue therapies at the low level viremia is more effective than delayed implementation.