Analogs in the treatment of chronic hepatitis B: real life experience with tenofovir and entecavir

INTRODUCTION: Tenofovir and entecavir are potent antiviral agents. By suppressing viral replication, they induce histological improvement and finally delay the progression of chronic hepatitis B and the development of complications. They are rarely associated with serious side effects. Our data from a real life experience support data from the literature and suggest some minimal difference that may be useful in tailoring therapy.PATIENTS AND METHODS: We retrospectively analyzed 54 patients affected by chronic hepatitis B (31 and 23 treated by entecavir and tenofovir, respectively). Eight patients were cirrhotic. At baseline and 4-12 and 24 weeks after starting therapy, biochemical and virological analysis were performed in all patients. Renal function tests (serum creatinine, creatinine clearance and blood urea), serum (calcium and phosphate blood level) and urine electrolyte were also studied.RESULTS: All the patients reached virological control within 24 weeks. Only in the group treated by tenofovir we observed a complete viral suppression within 12 weeks. Some patients treated with tenofovir showed increased creatinine clearance without serum creatinine alteration. No significant side effects were reported with the exception of one case of persistent headache in the entecavir group for which the drug was suspended.CONCLUSIONS: Entecavir and tenofovir are effective in suppressing viral replication in patients with chronic hepatitis B. Tenofovir is more potent than entecavir and viral replication is blocked within 12 weeks of therapy. Tenofovir administration is associated with slight increase of creatinine clearance without alteration of serum creatinine levels. The choice of one or the other should be made according to target and specific patients characteristics. In patients with high serum viral load where the complete and quick control of viral replication is the main target, tenofovir may represent the best choice.

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[Tenofovir and entecavir for chronic hepatitis B infection treatment: a single-center experience]

Clinical Management Issues ◽

10.7175/cmi.v9i4.1202 ◽

2015 ◽

Vol 9 (4) ◽

pp. 95-100

Author(s):

Fabio Tarsetti ◽

Giuseppe Tarantino ◽

Piergiorgio Mosca ◽

Emidio Scarpellini ◽

Giammarco Fava

Keyword(s):

Chronic Hepatitis ◽

Side Effects ◽

Hepatitis B ◽

Viral Replication ◽

Chronic Hepatitis B ◽

Genetic Resistance ◽

Abdominal Ultrasound ◽

Current Treatment ◽

Hepatitis B Infection ◽

Chronic Hepatitis B Infection

BACKGROUND AND AIM: The current treatment of chronic hepatitis B infection (CHBV) has achieved several step-ups thanks to the introduction of the new-generation nucleos(t)ide analogs. Entecavir and tenofovir have shown a high genetic resistance barrier and a low rate of side effects. In literature, there are a few studies comparing entecavir and tenofovir in the treatment of CHBV. Thus, we describe the results of our experience in managing CHBV patients with tenofovir vs. entecavir.MATERIALS AND METHODS: We have retrospectively evaluated, from 2007 to date, 20 CHBV patients treated with entecavir and tenofovir. All the patients underwent basal and periodical clinical follow-up, blood tests, virological tests, Fibroscan® test or liver biopsy and also upper abdominal ultrasound examination. Study endpoints were: viral replication inhibition, viral antigens seroconversion and transaminases normalization. Drug-associated side effects were also registered.RESULTS: After 12 weeks of therapy, entecavir and tenofovir lead to HBV-DNA negativization in 44% and 62% of patients, respectively. A case of viral seroconversion for HBeAg and HBsAg was evident in entecavir group, while no cases were registered in tenofovir group. After 12 weeks, 11% of entecavir treated patients and 37% of tenofovir treated patients showed normalization of transaminases.DISCUSSION: Tenofovir seems to exert a better viral replication inhibition (though not statistically significant) and to show transaminases improvement in comparison with entecavir, which, in turn, results more effective in HBeAg/HBsAg seroconversion. Both drugs have a high safety profile in terms of side effects.[Article in Italian]

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