In the treatment of HBV, there has been a lack of data to justify combination therapy. A presentation at AASLD showed that the mutant strains of HBV that emerged from treatment with Lamivudine increased the likelihood of a given patient’s developing resistance to Baraclude because the strains resistant to Baraclude were found to be a proper subset of the strains resistant to Lamivudine (#msg-14399529).
If, for example, Lamivudine and Baraclude were given as part of an HBV combination regimen, a likely outcome would be to expedite resistance to both drugs, rendering such a combination counter-productive. The same may hold for other combinations of nucleoside drugs including combinations with Tyzeka.
Thus, experts in the field consider combination therapy using a nucleoside and a nucleotide to be a more promising approach than combination therapy using two nucleosides (or two nucleotides).
The main nucleotide drug for HBV is Hepsera. Nucleotide drugs in development for HBV include tenofovir/Viread (GILD’s blockbuster for HIV) and ANA380 from ANDS.
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