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Lamivudine plus adefovir vs. entecavir in HBeAg-positive hepatitis B with sequential treatment failure of lamivudine and adefovir

 Chang Young Son  ;  Han Jak Ryu  ;  Jung Min Lee  ;  Sang Hoon Ahn  ;  Do Young Kim  ;  Myoung Ha Lee  ;  Kwang Hyub Han  ;  Chae Yoon Chon  ;  Jun Yong Park 
 LIVER INTERNATIONAL, Vol.32(7) : 1179-1185, 2012 
Journal Title
Issue Date
Adenine/analogs & derivatives* ; Adenine/therapeutic use ; Adult ; Alanine Transaminase/blood ; Antiviral Agents/therapeutic use* ; DNA, Viral/blood ; Drug Therapy, Combination ; Female ; Guanine/analogs & derivatives* ; Guanine/therapeutic use ; Hepatitis B/drug therapy* ; Hepatitis B e Antigens/analysis ; Hepatitis B e Antigens/metabolism* ; Hepatitis B, Chronic/drug therapy ; Hepatitis B, Chronic/virology ; Humans ; Lamivudine/therapeutic use* ; Male ; Middle Aged ; Organophosphonates/therapeutic use* ; Prognosis ; Retrospective Studies ; Treatment Failure
adefovir ; entecavir ; (HBeAg-positive)chronic hepatitis B ; lamivudine ; sequentialtherapy
BACKGROUND AND AIMS: Few studies have adequately examined the efficacy of lamivudine plus adefovir (LAM+ADV) combination therapy vs. entecavir (ETV) monotherapy in HBeAg-positive hepatitis B patients who fail to respond to sequential treatment with LAM and ADV. We compared directly the efficacy of LAM+ADV vs. ETV in such patients and assessed prognostic factors associated with a virologic response at month 12.

METHODS: In total, 72 HBeAg-positive patients who showed resistance (n = 33) or a suboptimal virologic response (n = 39) to ADV monotherapy with resistance to LAM therapy underwent rescue therapy (31 LAM+ADV and 41 ETV). All patients were followed for at least 12 months.

RESULTS: Following 12 months of treatment, in the LAM+ADV and ETV groups, a virologic response was observed in 7/31 (22.6%) and 8/41 (19.5%; P = 0.777) patients; ALT normalization occurred in 11/13 (84.6%) and 16/18 (88.9%; P = 0.566); HBeAg seroconversion in 1/31 (2.3%) and 4/41 (9.8%; P = 0.341) and a virologic breakthrough in 3/31 (9.0%) and 5/41 (12.1%; P = 0.452) respectively. Independent prognostic factors associated with a virologic response were the baseline HBV-DNA level (OR = 0.37; 95% CI 0.17-0.80; P = 0.011) and the duration of prior ADV monotherapy (OR = 0.89; 95% CI 0.83-0.95; P = 0.044).

CONCLUSIONS: Neither LAM+ADV nor ETV was adequately effective in patients with sequential LAM and ADV treatment failure. Thus, when chronic hepatitis B patients show resistance or suboptimal response to ADV monotherapy, early modification of treatment should be considered.
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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
Son, Chang Young(손창영)
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
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