Background & Aims: Tenofovir disoproxil fumarate (TDF), a nucleotide analogue and potent inhibitor of hepatitis B virus (HBV) polymerase, showed superior efficacy to adefovir dipivoxil in treatment of chronic hepatitis B through 48 weeks. We evaluated long-term efficacy and safety of TDF monotherapy in patients with chronic hepatitis B who were positive or negative for hepatitis B e antigen (HBeAg+or HBeAg-). Methods: After 48 weeks of double-blind comparison of TDF to adefovir dipivoxil, patients who underwent liver biopsy were eligible to continue the study on open-label TDF for 7 additional years; data presented were collected up to 3 years (week 144) from 85% of participants. Primary efficacy end points at week 144 included levels of HBV DNA and alanine aminotransferase, development of resistance mutations, and presence of HBeAg or hepatitis B surface antigen (HBsAg). Results: At week 144, 87% of HBeAg-and 72% of HBeAg+patients treated with TDF had levels of HBV DNA <400 copies/mL. Among patients who had previously received adefovir dipivoxil and then received TDF, 88% of the HBeAg-and 71% of the HBeAg+patients had levels of HBV DNA <400 copies/mL; overall, 81% and 74%, respectively, maintained normalized levels of alanine aminotransferase and 34% had lost HBeAg. Amino acid substitutions in HBV DNA polymerase that are associated with resistance to tenofovir were not detected in any patient. Cumulatively, 8% of HBeAg+patients lost HBsAg. TDF maintained a favorable safety profile for up to 3 years. Conclusions: TDF was safe and effective in the long-term management of HBeAg+and HBeAg-patients with chronic hepatitis B.

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Erasmus MC: University Medical Center Rotterdam

Heathcote, J., Marcellin, P., Buti, M., Gane, E., de Man, R., Krastev, Z., … Rousseau, F. (2011). Three-year efficacy and safety of tenofovir disoproxil fumarate treatment for chronic hepatitis B. Gastroenterology, 140(1), 132–143. doi:10.1053/j.gastro.2010.10.011