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Lamivudine plus adefovir vs. entecavir in HB eAg‐positive hepatitis B with sequential treatment failure of lamivudine and adefovir
Author(s) -
Son Chang Young,
Ryu Han Jak,
Lee Jung Min,
Ahn Sang Hoon,
Kim Do Young,
Lee Myoung Ha,
Han Kwang Hyub,
Chon Chae Yoon,
Park Jun Yong
Publication year - 2012
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2012.02793.x
Subject(s) - adefovir , lamivudine , entecavir , virology , medicine , hepatitis b , pharmacology , gastroenterology , hepatitis b virus , virus
Background and Aims Few studies have adequately examined the efficacy of lamivudine plus adefovir ( LAM + ADV ) combination therapy vs. entecavir ( ETV ) monotherapy in HB eAg‐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 HB eAg‐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); HB eAg 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.