Journal of Clinical Hepatology
This study included 117 HBeAg-negative chronic hepatitis B patients with incomplete response to initial treatment (HBV DNA ≥20 IU/mL after 1 year of treatment), comparing the efficacy and safety of combined therapy (original medicine + second nucleoside (acid) analog) with sequential therapy (discontinuing original medicine and replacing with new medicine). The results show that the viral clearance rate in the combined group was significantly higher than that in the sequential group at 24 and 48 weeks (95.92% vs 80.88%, P=0.016; 97.96% vs 86.76%, P=0.044), especially in the high viral load subgroup (≥10⁴ IU/mL), with a more obvious advantage; while there was no difference in efficacy between the two groups for patients with low viral load. There were no significant differences in the rate of ALT normalization and safety indicators such as renal function, myocardial enzymes, and blood lipids between the two groups.
Based on real-world clinical practice, this study is the first to systematically compare the stratified efficacy of combined and sequential strategies in the population with incomplete response, clarifying the precise intervention path of "priority for combined therapy in patients with high viral load and individualized choice for those with low viral load," filling the gap in current guidelines' recommendations for second-line treatment strategies. Its conclusions help optimize clinical decision-making, reduce the risk of resistance, enhance the potential for functional cure, and provide high-quality evidence-based support for the refinement and update of the WHO and China's new edition guidelines.
Objective: To investigate the efficacy and safety of combined versus sequential antiviral regimens in HBeAg-negative chronic hepatitis …
