Antiviral efficacies of currently available rescue therapies for multidrug-resistant chronic hepatitis B
Authors
Mi Sung Park ; Beom Kyung Kim ; Kyung Sik Kim ; Ja Kyung Kim ; Seung Up Kim ; Jun Yong Park ; Do Young Kim ; Oidov Baartarkhuu ; Kwang Hyub Han ; Chae Yoon Chon ; Sang Hoon Ahn
Citation
CLINICAL AND MOLECULAR HEPATOLOGY, Vol.19(1) : 29-35, 2013
Adenine/analogs & derivatives ; Adenine/therapeutic use ; Adult ; Aged ; Antiviral Agents/therapeutic use* ; DNA, Viral/blood ; Drug Resistance, Viral ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Genotype ; Guanine/analogs & derivatives ; Guanine/therapeutic use ; Hepatitis B e Antigens/blood ; Hepatitis B virus/genetics ; Hepatitis B, Chronic/drug therapy* ; Humans ; Lamivudine/therapeutic use ; Male ; Middle Aged ; Organophosphonates/therapeutic use ; Treatment Outcome
Keywords
Adefovir ; Entecavir ; Hepatitis B ; Hepatitis B virus ; Multidrug resistance
Abstract
Background/Aims: The incidence of multidrug-resistant (MDR) chronic hepatitis B (CHB) during sequential lamivudine (LAM) and adefovir dipivoxil (ADV) treatment is increasing. We investigated the antiviral efficacies of various rescue regimens in patients who failed sequential LAM-ADV treatment.
Methods: Forty-eight patients (83.3% of whom were HBeAg-positive) who failed sequential LAM-ADV treatment were treated with one of the following regimens: entecavir (ETV) (1 mg) monotherapy (n=16), LAM+ADV combination therapy (n=20), or ETV (1 mg)+ADV combination therapy (n=12). All patients had confirmed genotypic resistance to both LAM and ADV and were evaluated every 12 weeks.
Results: The baseline characteristics and treatment duration did not differ significantly among the study groups. During the treatment period (median duration: 100 weeks), the decline of serum HBV DNA from baseline tended to be greatest in the ETV+ADV group at all-time points (week 48: -2.55 log10 IU/mL, week 96: -4.27 log10 IU/mL), but the difference was not statistically significant. The ETV+ADV group also tended to have higher virologic response rates at 96 weeks compared to the ETV monotherapy or LAM+ADV groups (40.0% vs. 20.0% or 20.0%, P=0.656), and less virologic breakthrough was observed compared to the ETV monotherapy or LAM+ADV groups (8.3% vs. 37.5% or 30.0%; P =0.219), but again, the differences were not statistically significant. HBeAg loss occurred in one patient in the ETV+ADV group, in two in the ETV monotherapy group, and in none of the LAM+ADV group. The safety profiles were similar in each arm.
Conclusions: There was a nonsignificant tendency toward better antiviral efficacy with ETV+ADV combination therapy compared to LAM+ADV combination therapy and ETV monotherapy for MDR CHB in Korea, where tenofovir is not yet available.