Potential conflict of interest: Nothing to report.
The curative efficiency of tenofovir for patients with chronic hepatitis B after failure of nucleoside/nucleotide analogues†
Article first published online: 1 MAR 2010
Copyright © 2010 American Association for the Study of Liver Diseases
Volume 52, Issue 2, page 802, August 2010
How to Cite
Chen, E.-Q. and Tang, H. (2010), The curative efficiency of tenofovir for patients with chronic hepatitis B after failure of nucleoside/nucleotide analogues. Hepatology, 52: 802. doi: 10.1002/hep.23630
- Issue published online: 23 JUL 2010
- Article first published online: 1 MAR 2010
To the Editor:
Recently, we read with interest the article by van Bömmel et al.1 on tenofovir disoproxil fumarate (TDF) monotherapy for patients who failed to improve with other nucleoside/nucleotide analogues (NUC). Their findings showed that TDF monotherapy could induce a potent and long-lasting antiviral response in other NUC failure patients. However, we still have some questions to discuss.
According to Asian Pacific Association for the Study of the Liver (APASL) and European Association for the Study of the Liver (EASL) guidelines,2, 3 primary nonresponse (PNR) is defined as a decrease in hepatitis B virus (HBV) DNA by <1 log10 IU/mL at week 12. But in the American Association for the Study of Liver Diseases (AASLD) guidelines,4 it is defined as a decrease in HBV DNA by <2 log10 IU/mL at week 24. Thus, we can see the time point at which determination of PNR in NUC treatment is still controversial. In this study, we thought it might not be good to define PNR at week 12 as treatment failure. We also speculated that some of the included patients might not represent “true failure” of a preceding treatment. For example, in adefovir-treated patients with nonresponse at week 12, if preceding treatment was continued but not switched to TDF, good virological response also might be reached. We suspected the efficacy of TDF for those patients may be not as good as reported. If patients with nonresponse were excluded from 131 eligible patients, the efficacy data of TDF may be more reasonable and valuable to us. If possible, we expect professor van Bömmel to be able to share relevant results with us.
We are also interested whether there were patients who presented with so-called nonresponse during TDF treatment. In the present study, the decrease of HBV DNA in TDF treatment was only assessed at 12 months and at the end of follow-up. If specific data on a decrease in HBV DNA at week 12 or 24 of TDF treatment were also shared, it would give us a more comprehensive understanding of the curative efficacy of TDF rescure therapy.
In addition, we would like to point out there was a typographic error of the age in table 1. The range of age should be 18-77, not 17-77.
- 1Long-term efficacy of tenofovir monotherapy for hepatitis B virus-monoinfected patients after failure of nucleoside/nucleotide analogues. HEPATOLOGY 2010; 51: 73-80., , , , , , et al.
- 2European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of chronic hepatitis B. J Hepatol 2009; 50: 227-242.
- 3Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2008 update. Hepatol Int 2008; 2: 263-283., , , , , , et al.
- 4Chronic hepatitis B: update 2009. HEPATOLOGY 2009; 50: 661-662., .
En-Qiang Chen M.D.*, Hong Tang M.D.*, * Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan, China.