[5-7] Considering the antiviral potency and resistance profile, E

[5-7] Considering the antiviral potency and resistance profile, ETV and TDF are the preferred first-line agents to treat CHB patients.[5-7] In Taiwan, ADV is only approved as a rescue agent in combination with ETV, LVD,

or LdT for the treatment of nucleoside-resistant HBV strains.[9] The efficacy of approved NAs has been demonstrated in their respective pivotal trials.[10-15] However, pivotal trials generally evaluate 1-year (i.e. 48 weeks) Rapamycin research buy or extended 2-year efficacy and safety end-points, and the results may not be extrapolated to a wider spectrum of patients in clinical practice, the majority of whom need prolonged treatment. Hence, postmarketing observational studies are needed to demonstrate the effectiveness of these agents in a real-world setting. In the Asia Pacific region including Taiwan, NAs with less potency and low genetic barrier are commonly used as initial antiviral agents because of medical resource constraints.

Whether the initial choice of antiviral treatments affects sustained virological suppression, drug resistance and treatment modification in patients with prolonged NA treatment remain largely unclear and deserves further studies. In Taiwan, the Bureau of National Health Insurance reimburses NA treatment for up to 3 years in treatment-naïve CHB patients Nutlin3a if there is no virological evidence of drug resistance during the treatment period. This reimbursement policy prompted us to conduct a multicenter observational study to investigate the treatment efficacy, treatment modification, and adherence in CHB patients receiving 3-year NA treatment. This multicenter observational study was learn more conducted in outpatient departments of 33 randomly selected regional hospitals or medical centers in Taiwan. From August 2008 to July 2009, we identified 600 NA-naïve patients who were at least 16 years of age and who had a diagnosis of compensated CHB. All patients received a 3-year NA treatment and had a regular follow-up; the selection of NA was according to the physicians’ discretion. Patients who received interferon or oral NA or a combination

treatment of interferon plus oral NA treatment, those with coinfection of hepatitis C virus, hepatitis delta virus, or human immunodeficiency virus, and those who participated in other clinical studies or who had decompensated liver disease were excluded. Written informed consent was obtained from each patient at enrollment. The study protocol and protocol amendment were approved by the Institutional Review Board/Independent Ethics Committee of each participating hospital or center. Baseline data of patients were retrieved from the medical records and included age, gender, medical history, HBV DNA level (IU/mL), hepatitis B surface antigen/anti-HBs and hepatitis B e antigen (HBeAg)/anti-HBe, levels of serum alanine aminotransferase (ALT), albumin, total bilirubin and creatinine, and initial NA treatment.

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