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Efficacy of adefovir add-on lamivudine rescue therapy compared with switching to entecavir monotherapy in patients with lamivudine-resistant chronic hepatitis B.

Authors
 Han Jak Ryu  ;  Jung Min Lee  ;  Sang Hoon Ahn  ;  Do Young Kim  ;  Myoung Ha Lee  ;  Kwang-Hyub Han  ;  Chae Yoon Chon  ;  Jun Yong Park 
Citation
 JOURNAL OF MEDICAL VIROLOGY, Vol.82(11) : 1835-1842, 2010 
Journal Title
 JOURNAL OF MEDICAL VIROLOGY 
ISSN
 0146-6615 
Issue Date
2010
MeSH
Adenine/administration & dosage ; Adenine/analogs & derivatives* ; Adenine/pharmacology ; Adult ; Aged ; Antiviral Agents/administration & dosage* ; Antiviral Agents/pharmacology ; Drug Resistance, Viral/drug effects* ; Drug Therapy, Combination ; Female ; Guanine/administration & dosage ; Guanine/analogs & derivatives* ; Guanine/pharmacology ; Hepatitis B virus/drug effects* ; Hepatitis B, Chronic/drug therapy* ; Hepatitis B, Chronic/virology ; Humans ; Lamivudine/administration & dosage* ; Lamivudine/pharmacology ; Male ; Middle Aged ; Organophosphonates/administration & dosage* ; Organophosphonates/pharmacology ; Treatment Outcome ; Young Adult
Keywords
lamivudine ; adefovir dipivoxil ; entecavir ; chronic hepatitis B ; resistant mutants
Abstract
No study has reported on the comparative effect of adefovir (ADV) add-on lamivudine (LAM) versus switching to entecavir (ETV) in LAM-resistant patients with chronic hepatitis B. From October 2007 to September 2008, 92 consecutive LAM-resistant patients were enrolled (47 LAM+ADV and 45 ETV 1 mg). All patients were followed for at least 12 months. The parameters assessed included normalization of ALT, HBeAg seroconversion, undetectable HBV DNA, reduction of HBV DNA, and predictors of virologic response. In the LAM+ADV and ETV groups, the baseline DNA levels were 7.61 (5.19-9.49) and 7.10 (5.43-9.74)log(10)copies/ml, respectively. At month 12, a virologic response occurred in 18/47 (38.3%) and 11/45 (24.4%; P=0.182) patients; ALT normalization, in 39/41 (95.1%) and 36/40 (90.0%; P=0.432); HBeAg seroconversion, in 5.1% and 2.4% (P=0.606); and virologic breakthrough, in 2.1% and 11.1% (P=0.107), respectively. The mean reduction from the baseline HBV DNA level was greater in the LAM+ADV group at month 12 (3.80 ± 1.12 vs. 2.7 ± 1.32 log(10)copies/ml; P<0.001). In the multivariate analysis, the independent parameters related to a virologic response at month 12 were baseline ALT (OR=1.003, 95% CI=1.000-1.006, P=0.026) and baseline HBV DNA (OR=0.495, 95% CI=0.298-0.823, P=0.007). Compared with switching to ETV monotherapy, ADV add-on LAM therapy was more effective at reducing the viral load in patients with LAM resistance, and the baseline HBV DNA and ALT levels were independent predictors of the virologic response. However, ADV add-on therapy had limitations in patients with a higher baseline HBV DNA in LAM rescue therapy.
Full Text
http://onlinelibrary.wiley.com/doi/10.1002/jmv.21898/abstract
DOI
10.1002/jmv.21898
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Ryu, Han Jak(류한작)
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Lee, Myoung Ha(이명하)
Lee, Jung Min(이중민)
Chon, Chae Yoon(전재윤)
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/101881
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