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Outcome of adefovir add‐on lamivudine rescue therapy of up to 5 years in patients with lamivudine‐resistant chronic hepatitis B
Author(s) -
Kim Sung Bae,
Kim Seung Up,
Kim Beom Kyung,
Park Jun Yong,
Kim Do Young,
Ahn Sang Hoon,
Han KwangHyub
Publication year - 2016
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/jgh.13046
Subject(s) - lamivudine , adefovir , medicine , rescue therapy , chronic hepatitis , virology , hepatitis b , gastroenterology , antiviral therapy , virus
Background and Aim: We investigated the long‐term efficacy of adefovir add‐on lamivudine rescue therapy in lamivudine‐resistant chronic hepatitis B and the optimal cutoff hepatitis B virus (HBV) DNA level that predicts complete virological response (CVR) among patients without CVR after 1 year of treatment. Methods: We reviewed 167 lamivudine‐resistant chronic hepatitis B patients who received adefovir add‐on rescue therapy for up to 5 years. Multivariate analysis, area under the receiver operating characteristic curves, and Youden index were used. Results: Median age was 47.0 years; 112 patients were male. Median baseline HBV DNA level was 6.6 log 10 IU/mL; hepatitis B e antigen was positive in 130 (77.4%) patients. Five‐year CVR, alanine aminotransferase normalization, hepatitis B e antigen seroconversion, and adefovir resistance rates were 86.9%, 92.5%, 16.7%, and 6.0%, respectively. One‐year HBV DNA level independently associated with CVR. Optimal cutoff HBV DNA level to predict CVR among patients who failed to achieve CVR at 1 year was 800 IU/mL (area under receiver operating characteristic curve 0.752; sensitivity 49.3%, specificity 93.5%). During the 5‐year treatment, 92.1% of patients with favorable response (HBV DNA < 800 IU/mL at 1 year) achieved CVR; 45.6% achieved CVR among suboptimal responders (HBV DNA ≥ 800 IU/mL at 1 year) ( P < 0.001). Conclusion: Complete virological response or HBV DNA level < 800 IU/mL after 1 year adefovir add‐on lamivudine rescue therapy can favorably predict CVR.