Why take Viread when Baraclude has less sides?

I've been comparing these two drugs lately, and it seems to me that Baraclude is safer as a first drug.  

They are both about equally effective and resistant (against mutations).  The main difference that I'm seeing here is that Viread has more serious side effects: reduced bone density, more toxic to the kidneys, and possible changes in body fat.  Viread offers a 5% chance of loss of HBsAg in 48 weeks while Baraclude offers a 5% chance in 96 weeks.

Why not just take Baraclude?

[stef2011]

it all depends.....

etv, no relevant or detactable sides but animal trials had lung cancer at doses little higher than humans, all rodents had cancers but not monkeys.so they approved it keeping it under cancer monitoring

less potency

resistance if lam mutants or other mutants already present at very high rates

if no lam mutants resistance is 1,5% at 6 years.in clinical practice resistance and non responce this has been found little higher

tenofovir, we know the sides because in use since 11 years for hiv, etv is only about 6 years and on very few people compared to etv

this is relevant anyway:
kidneys tox only when kidneys are already damaged.it has been found that severe liver damage f3-f4 has more kidneys damage.there are no tests to detect kidneys damage so you will find out about it only taking drugs heavy on kidneys
normal kidneys on hbv patients have no damage from tnf.data from hiv people not relevant because they use much more drugs and usually come from unhealthy lifestyles/drugs

reduced bone density, possible changes in body fat, this was on hiv people, still not confirmed on hbv

[stef2011]

immune response and clearance of hbv on etv, hbsag clearance:
hbeag pos
about 5-10%

hbeag neg
5%

combo interferon+etv
drug companies have data on small and bigger trials but it is kept not public

[stef2011]

immune response and clearance of hbv on tnf, hbsag clearance:

hbeag pos
16% at 3 years and still rising

hbeag neg
0%

combo interferon+tnf
drug companies have data on small and bigger trials but it is kept not public but i have got info from inside sources:

interferon 6 months+tnf and then tnf monotherapy 26%
dot know if this is on hbeag pos or neg, but if you consider than 6 months on interferon makes no sense the percentage can increase much more especially if tnf is started first or staggered

[stef2011]

all this said i think the best thing is to personalize according to everyone situation

i choose etv because:
on cirrhosis and we have data on cirrhosis regression at 6 years of etv (tnf at 6 years might do the same but we dont have this data)

i tried combo which makes sense on cirrhosis etv+tnf for 1 week but creatinine got high immediately even at half tnf dose

i am on many experimental combos and waiting for interferon lambda because even if it is only 1,5% resistance somebody will end in that small percentage and having 3-4 mutants from etv is not nice even if tnf might still work

[stef2011]

forgot to say tnf has 0% resistance

new version with imprved potency with no kidneys tox is ready and on hiv human trials now.
it is not a new drug and should have no patent, tnf is just carried in the cells inside a different chemical.anyway tnf patent will exp 2015-2017, we will probably have this tnf by then.
drug company is called chimerix or similar

a mono of both drugs is pretty stupid today, a staggered combo with interferon is much better

[stef2011]

here is why i am so afraid of mutants present before strting therapy and during therapy

Unsuccessful therapy with interferon - lam - adefovir and entecavir-tenofovir
http://www.biomedcentral.com/1471-2334/11/178

[precipice]

Thanks for the comments stef.  One statistic confused me: hbsag clearance is 0% for hbeag neg patients on tenofovir.  I tried digging to confirm this statistic but couldn't find it.. perhaps it matters not, as clearance is not something to bet on.

One other note is that it appears Baraclude is approved in Japan, while Viread is not.  Both antivirals are approved in Taiwan.  As Asian countries have higher rates of Hepatitis B, I thought it'd be interesting to see what they were using.

I'm still undecided at this point.  A combination of both would seem to be a "diversified choice," but I think I read that stef also had creatine levels spike upon combining them.  Somehow, Baraclude seems "safer" in my mind still, although my doctor seemed to be pushing for Viread quite strongly.  Still a bit of a coin toss.

[grmr]

i'm eag+ i really wish they could put me on antivirals as I already went through a non responding PEG IFN tx....

the risk is that if someone starts Antivirals he cannot quit whenrever he wants and may stay on those for all the life.. and so far no data on toxicity on long period are available..