21 May 2018
Int J Med Sci 2013; 10(5):567-574. doi:10.7150/ijms.5795
Adherence to Medication Is a More Important Contributor to Viral Breakthrough in Chronic Hepatitis B Patients Treated with Entecavir Than in Those with Lamivudine
1. Departments of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan;
Viral breakthrough is related to poor adherence to medication in some chronic hepatitis B patients treated with nucleos(t)ide analogues (NAs). Our study aimed to examine how adherence to medication is associated with viral breakthrough in patients treated with NAs. A total of 203 patients (135 ETV and 68 LAM) were analyzed in this retrospective analysis. Physical examination, serum liver enzyme tests, and hepatitis B virus marker tests were performed at least every 3 months. We reviewed medical records and performed medical interviews regarding to patients' adherence to medication. Adherence rates <90% were defined as poor adherence in the present study. Cumulative viral breakthrough rates were lower in the ETV-treated patients than in the LAM-treated patients (P<0.001). Seven ETV-treated (5.1%) and 6 LAM-treated patients (8.8%) revealed poor adherence to medication (P=0.48). Among ETV-treated patients, 4 (3.1%) of 128 patients without poor adherence experienced viral breakthrough and 3 (42.8%) of 7 patients with poor adherence experienced viral breakthrough (P<0.001). Only 3 of 38 (7.8%) LAM-treated patients with viral breakthrough had poor adherence, a lower rate than the ETV-treated patients (P=0.039). Nucleoside analogue resistance mutations were observed in 50.0% of ETV- and 94.1% of LAM-treated patients with viral breakthrough (P=0.047). Viral breakthrough associated with poor adherence could be a more important issue in the treatment with especially stronger NAs, such as ETV.
Keywords: Adherence, Entecavir, Lamivudine, Hepatitis B, Viral Breakthrough.
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How to cite this article:
Kamezaki H, Kanda T, Arai M, Wu S, Nakamoto S, Chiba T, Maruyama H, Fujiwara K, Kanai F, Imazeki F, Nomura F, Yokosuka O. Adherence to Medication Is a More Important Contributor to Viral Breakthrough in Chronic Hepatitis B Patients Treated with Entecavir Than in Those with Lamivudine. Int J Med Sci 2013; 10(5):567-574. doi:10.7150/ijms.5795. Available from http://www.medsci.org/v10p0567.htm