An article in the June issue of Pharmacotherapy describes
how a combination of the antivirals tenofovir and emtricitabine (Truvada)
successfully replaced costly HBIG (hepatitis B immune globulin) to prevent
recurrence of hepatitis B in four liver transplant patients.
—Christine. M. Kukka, Project Manager, HBV Advocate
Abstract: Recurrence in Four Patients After
Liver Transplantation.
Creighton School of Pharmacy and
Health Professions, Creighton University, Omaha, Nebraska.
Introduction:
In patients infected with chronic
hepatitis B virus (HBV) that goes untreated, therapeutic options are limited
once the disease decompensates, and orthotopic liver transplantation is often
the only treatment available to save the patient's life. After liver
transplantation, combined therapy with hepatitis B immune globulin (HBIG) and a
nucleos(t)ide analog is the standard of practice for the prevention of HBV recurrence.
Historically, nucleos(t)ide analogs such as lamivudine and adefovir have been
used with low-dose HBIG for the prevention of HBV recurrence after liver
transplantation. However, these analogs are ineffective when used alone due the
emergence of resistance mutations. Newer nucleos(t)ide analogs such as
tenofovir disoproxil fumarate have demonstrated higher resistance thresholds
and effective viral suppression when paired with low-dose HBIG.
Results:
In this case series, we evaluated
the safety and efficacy of switching four patients from low-dose HBIG plus
nucleos(t)ide analog therapy for the prevention of HBV recurrence to a
combination tenofovir-emtricitabine regimen. At the end of follow-up, all
patients remained hepatitis B surface antigen negative and had HBV DNA levels
of less than 10 IU/ml. Additionally, no tenofovir-associated
nephrotoxicity was observed among the four patients.
Conclusion:
Tenofovir-emtricitabine monotherapy
in lieu of HBIG plus nucleos(t)ide analog therapy demonstrated prevention of
HBV recurrence without tenofovir-associated nephrotoxicity after 9 months
of follow-up in all four patients and up to 15 months in one patient.
2013 Jun 6. doi: 10.1002/phar.1306. [Epub ahead of print]
Labels: liver transplant, recurrence, treatment options, Truvada (tenofovir and emtricitabine)