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Rescue therapy for lamivudine‐resistant chronic hepatitis B: Comparison between entecavir 1.0 mg monotherapy, adefovir monotherapy and adefovir add‐on lamivudine combination therapy
Author(s) -
Kim Hong Joo,
Park Jung Ho,
Park Dong Il,
Cho Yong Kyun,
Sohn Chong Il,
Jeon Woo Kyu,
Kim Byung Ik
Publication year - 2010
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2010.06381.x
Subject(s) - adefovir , medicine , entecavir , lamivudine , combination therapy , gastroenterology , hepatitis b , hbeag , alanine transaminase , chronic hepatitis , hepatitis b virus , virology , virus , hbsag
Background and Aim: There have been no reports comparing the therapeutic results of adefovir (ADV) and entecavir (ETV) rescue therapy for patients with lamivudine (LAM)‐resistant chronic hepatitis B (CHB). We aimed to compare the cumulative efficacy and resistance of ETV 1.0 mg monotherapy, ADV monotherapy and ADV add‐on LAM combination therapy in LAM‐refractory patients. Methods: One hundred and four patients were included in the following three treatment groups; group 1 ( n = 24), LAM was switched to ETV (1.0 mg once a day); group 2 ( n = 44), LAM was switched to ADV (10 mg once a day); and group 3 ( n = 36), ADV was added to LAM (10 mg once a day). Results: After 6 months of rescue treatment, alanine aminotransferase normalization was observed in 75.0%, 65.9% and 74.3% of patients receiving ETV monotherapy, ADV monotherapy and ADV add‐on therapy, respectively. A significantly higher log 10 HBV‐DNA drop at 6 months occurred in the ADV add‐on group compared with the ETV group. The rate of HBV‐DNA polymerase chain reaction undetectability (<300 copies/mL) 6 months after initiation of ETV monotherapy, ADV monotherapy and ADV add‐on therapy was 33.3%, 27.3% and 68.6%, respectively ( P = 0.003). The cumulative HBeAg seroconversion rate was significantly higher in ADV add‐on/ADV monotherapy groups compared with the ETV monotherapy group ( P = 0.022). Viral breakthrough and genotypic resistance were detected in six (25.0%) and six (13.6%) patients in the ETV and ADV monotherapy groups, whereas no cases of genotypic resistance were detected in ADV add‐on group 24 months after initiation of antiviral treatment ( P < 0.01). Conclusion: Adefovir add‐on treatment in patients with LAM‐resistant CHB suppresses HBV replication more effectively than ETV or ADV monotherapy. Additionally, no genotypic resistance was detected in the ADV add‐on group.