Entecavir plus Adefovir in Lamivudine-Resistant Chronic Hepatitis B Patients wit

StephenW

Antimicrob Agents Chemother. 2012 Mar 19. [Epub ahead of print]
Entecavir plus Adefovir in Lamivudine-Resistant Chronic Hepatitis B Patients with suboptimal Response to Lamivudine plus Adefovir : A Randomized Trial.Lim YS, Lee JY, Lee D, Shim JH, Lee HC, Lee YS, Suh DJ.
SourceDepartment of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

AbstractA substantial proportion of patients with lamivudine-resistant hepatitis B virus (HBV) show suboptimal virologic response during rescue combination treatment with lamivudine plus adefovir. In this randomized active-control trial, 90 patients with serum HBV DNA >2000 IU/mL after at least 24 weeks of treatment with lamivudine plus adefovir therapy for lamivudine-resistant HBV were randomized to combination treatment with entecavir plus adefovir (ETV+ADV, n=45) or continuation of lamivudine plus adefovir (LAM+ADV, n=45) for 52 weeks. At baseline, patients' mean serum HBV DNA was 4.60 log(10) IU/mL (SD 1.03). All 90 patients completed 52 weeks of treatment. At week 52, the proportion of patients with serum HBV DNA <60 IU/mL, the primary endpoint, was significantly higher in the ETV+ADV group than in the LAM+ADV group (n=13, 29% vs. n=2, 4%; P=0.004). The mean reduction in serum HBV DNA levels from baseline was significantly greater in the ETV+ADV group than in the LAM+ADV group (-2.2 log(10) IU/mL vs. -0.6 log(10) IU/mL; P<0.001). At week 52, additional resistance mutations to adefovir or entecavir were analyzed in all patients with detectable HBV DNA by restriction fragment mass polymorphism assays, and detected in none in the ETV+ADV group, but in 15% of patients in the LAM+ADV group (P=0.018). Safety and adverse event profiles were similar in the two groups. In conclusion, entecavir plus adefovir combination therapy provides superior virologic response and favorable resistance profiles, compared with continuing lamivudine plus adefovir combination, in patients with lamivudine-resistant HBV who fail to response to lamivudine plus adefovir combination therapy.

StephenW

抗菌试剂及化学。 2012年3月19。 [出处提前打印]
恩替卡韦，加上阿德福韦治疗拉米夫定耐药慢性乙型肝炎患者用拉米夫定加阿德福韦反应欠佳：一项随机试验。
黏林，李精云，李沉歼轰，李HC，李黏，SUH DJ。
源

消化内科，肝病中心，大韩民国，汉城峨山医学中心，蔚山大学医学院学院。
抽象

拉米夫定抗乙型肝炎病毒（HBV）患者的一个相当大的比例，表明救援组合拉米夫定联合阿德福韦治疗期间病毒学应答欠佳。在这个随机主动对照试验，90例患者血清HBV DNA> 2000 IU / mL的治疗与拉米夫定联合阿德福韦酯治疗拉米夫定耐药HBV后至少24周的随机结合治疗，恩替卡韦联合阿德福韦（教育电视+动词N = 45）或拉米夫定+阿德福韦（林+动词，N = 45），为期52周的延续。基线时，患者的平均血清HBV DNA为4.60日志（10）IU /毫升（SD 1.03）。所有90例患者完成52周的治疗。 52周时，患者血清HBV DNA的比例<60 IU / mL时，主要终点，在教育电视+ ADV组显着高于林+ ADV组（13例，29％与N = 2 4％，P = 0.004）。在血清HBV DNA水平从基线平均减少在教育电视+ ADV组显着大于林+ ADV组（-2.2日志（10）IU / mL的-0.6日志（10）IU /毫升，P < 0.001）。 52周时，额外阿德福韦或恩替卡韦耐药突变进行了分析，在所有患者检测乙肝病毒DNA限制性片段质量多态性检测，并在教育电视+ ADV组没有检测到，但在15％的患者在LAM + ADV组（p = 0.018）。安全性和不良事件的概况，在两组相似。总之，恩替卡韦，加上阿德福韦联合治疗提供了优越的病毒学应答和良好的耐型材相比，具有持续拉米夫定加拉米夫定耐药HBV拉米夫定+阿德福韦联合治疗失败的患者阿德福韦组合。

9病成医

在拉米耐药后,换用恩替加阿德效果好于拉米加阿德,只是用药成本增加一倍.慢乙肝治疗是极长期的事情,药物的经济性也是关键的选择.

咬牙硬挺

感谢分享啊论坛难上