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Title: Patterns of managing chronic hepatitis B treatment-related drug resistance: A survey of physicians in Mainland China, South Korea, Taiwan, and Thailand
Authors: Siwaporn Chainuvati
Jun Cheng
Jin Lin Hou
Chao Wei Hsu
Ji Dong Jia
Piyawat Komolmit
So Young Kwon
Chang Hong Lee
Hong Li
Ying Li
Chun Jen Liu
Boon Leong Neo
Cheng Yuan Peng
Tawesak Tanwandee
Suchat Wongcharatrawee
Jaw Ching Wu
Ming Lung Yu
Xin Xin Zhang
Mahidol University
Beijing Ditan Hospital
Southern Medical University
Chang Gung University College of Medicine
Capital Medical University China
Chulalongkorn University
Konkuk University, College of Medicine
Bristol-Myers Squibb
National Taiwan University
China Medical University Hospital Taichung
National Yang-Ming University, School of Medicine
Kaohsiung Medical University Chung-Ho Memorial Hospital
Kaohsiung Medical University
Ruijin Hospital
Keywords: Medicine
Issue Date: 24-Jun-2009
Citation: Hepatology International. Vol.3, No.3 (2009), 453-460
Abstract: Purpose: The emergence of antiviral resistance can negate the benefits of antiviral therapy in patients with chronic hepatitis B (CHB). This study aimed to assess how physicians in Asia manage suspected antiviral resistance. Methods: Randomly selected CHB-treating physicians in Mainland China, South Korea, Taiwan, and Thailand underwent a face-to-face interview. A standardized questionnaire was used to assess how physicians identify, monitor, and manage suspected resistance and its associated medical costs. Results: We interviewed 575 physicians from January to May 2008. Most physicians preferred a "prevention-of-antiviral resistance" strategy over a "rescue-once-resistance-develops" strategy. Physicians had encountered lamivudine resistance most frequently (96 - 100% of respondents), followed by the resistance to adefovir (18 - 58%) and entecavir (3 - 7%). While physicians in South Korea and Taiwan have access to resistance testing, physicians in Mainland China and Thailand have limited access to resistance testing but rely on HBV DNA and alanine aminotransferase (ALT) tests to identify resistance. Once resistance is suspected, 60% of the physicians in Mainland China, South Korea, and Thailand monitored these patients quarterly and the remaining 40% opted for monthly follow-up. In comparison, 70% of the Taiwanese physicians monitored these patients monthly. The average total direct medical costs, excluding antiviral costs, to manage a patient during the first year after suspected resistance is identified ranged from USD $319 to USD $709. Conclusions: Limited access to HBV resistance tests causes physicians in Asia to manage suspected resistance by various HBV DNA assays and ALT tests. This raises concerns that resistance may not be detected early enough to be rescued efficiently. © Asian Pacific Association for the Study of the Liver 2009.
ISSN: 19360541
Appears in Collections:Scopus 2006-2010

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