HEPATOLOGY Rescue therapy for lamivudine-resistant chronic hepatitis B: Comparison
between entecavir 1.0 mg monotherapy, adefovir monotherapy and adefovir add-on
lamivudine combination therapy
Hong Joo Kim, Jung Ho Park, Dong Il Park, Yong Kyun Cho, Chong Il Sohn, Woo
Kyu Jeon and Byung Ik Kim
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan
University, Seoul, Korea
Correspondence to Professor Hong Joo Kim, Department of Internal Medicine,
Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108,
Pyung-Dong, Jongro-Ku Seoul, Korea. Email: [email protected]
Author's contributions: HJ Kim, JH Park, DI Park, YK Cho, CI Sohn, WK Jeon,
and BI Kim had the original idea for the study, and shared responsibility
equally for data collection, data processing, statistical analyses, writing,
and reviewing the manuscript.
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 log10HBV-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.
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Accepted for publication 25 February 2010.
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1440-1746.2010.06381作者: zasxz 时间: 2010-8-26 08:57
thank you . ADV add on therapy is better than ETV 1.0mg alone and ADV monotherapy