Adefovir-based combination therapy with entecavir or lamivudine for patients with entecavir-refractory chronic hepatitis B

✍ Scribed by Soon Sun Kim; Jae Youn Cheong; Dami Lee; Myoung Hee Lee; Sun Pyo Hong; Soo-Ok Kim; Sung Won Cho

• Publisher: John Wiley and Sons
• Year: 2011
• Tongue: English
• Weight: 160 KB
• Volume: 84
• Category: Article
• ISSN: 0146-6615
• DOI: 10.1002/jmv.22227

✦ Synopsis

This study evaluated the efficacy of adefovir (ADV) plus lamivudine (LAM) or ADV add-on therapy for patients with entecavir (ETV)-refractory hepatitis B infection. Twenty-nine ETVresistant and 8 patients with suboptimal response to ETV were enrolled. Twenty-seven patients received ADV þ LAM therapy and 10 patients received ADV þ ETV therapy for >24 weeks. In 29 patients who were ETV-resistant, the mean reduction in HBV DNA levels at 24 weeks was not different between the ADV þ LAM and ADV þ ETV groups (À1.98 log 10 IU/ml vs. À2.16 log 10 IU/ml; P ¼ 0.792). Primary nonresponse was observed in 52.2% (12/23) of ADV þ LAM group and 33.3% (2/6) of ADV þ ETV group (P ¼ 0.651). Initial virologic response (IVR) was observed in 17.4% (4/23) of ADV þ LAM group and 33.3% (2/6) of ETV þ ADV group (P ¼ 0.362). In eight patients with suboptimal response to ETV, the ADV þ ETV group had a greater reduction in HBV DNA at 24 and 48 weeks than the ADV þ LAM group (À2.29 log 10 IU/ml vs. À0.09 log 10 IU/ml and À2.04 log 10 IU/ml vs. À0.72 log 10 IU/ml; P ¼ 0.020 and P ¼ 0.012, respectively). Primary nonresponse and IVR did not significantly differ between the two groups [100% (4/4) vs. 50% (2/4) and 0% (0/4) vs. 50% (2/4); P ¼ 0.429 and P ¼ 0.429, respectively]. The antiviral efficacies of ADV-based therapy with ETV or LAM for patients with ETV-resistant hepatitis B were limited and did not differ between the two groups. However, adding ADV to ETV may be more effective than ADV þ LAM therapy in patients with suboptimal virologic response to ETV.