Recommendations for the use of nucleos(t)ide analogues in clinical practice
| Drug | Advantage | Disadvantage | Recommendation |
| Lamivudine (LAM) | Low treatment costs Oral solution available for children or individual dosage in case of renal impairment | Hight risk of resistance in long- term monotherapy Cross-resistance to ETV and LdT | Use as first-line therapy only in selected patients with low viral load Use in pregnancy possible |
| Adefovir dipivoxil (ADV) | Experience in combination with LAM No cross-resistance to LAM | Moderate antiviral activity Primary nonresponse in 10–20% of cases Slow viral kinetics during therapy Risk of viral resistance in longterm monotherapy Nephrotoxicity | Not to be used as firstline or mono therapy |
| Telbivudine (LdT) | High antiviral efficacy No cross-resistance to entecavir | Moderate risk for viral resistance in long-term monotherapy Neuropathy and myopathy | First-line therapy Can be combined with TDF |
| Entecavir (ETV) | High antiviral efficacy Low risk for viral resistance in longterm monotherapy in lamivudine-naïve patients Combination therapy with TDF as rescue therapy Oral solution available for individual dosage in case of renal impairment | In LAM – experienced patients high risk for the development of viral resistance and virologic failure in long-term monotherapy | First-line therapy Can be combined with TDF Recommended for pre-emptive treatment in patients with immunosuppression |
| Tenofovir disoproxil fumarate (TDF) | High antiviral efficacy Low risk for viral resistance in long-term monotherapy Oral solution available for individual dosage in case of renal impairment | Rare Nephrotoxicity* Decrease in bone mineral density | First- and any second-line therapy Can be combined with ETV, LdT or LAM if needed Recommended for pre-emptive treatment in patients with immunosuppression |
| Tenofovir alafenamide (TAF) | Comparable antiviral efficacy as TDF in HBeAg positive and negative patients Smaller risk of bone density loss or kidney damage than TDF | First- and second line treatment for patients with compensated liver disease |
Author Profile
Dr. D.Zeqiraj medical doctor at QKUK- Pristina, department of Infectious disease.