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发表于 2002-7-27 19:18
******
From: "Doc" gidoc@XXXXXXX
To: [email protected]
Subject: [HB] Long term use of Adefovir
Date: Tue, 23 Jul 2002 17:14:29 +0530
SUSTAINED ANTIVIRAL RESPONSE AND LACK OF VIRAL RESISTANCE WITH LONG TERM ADEFOVIR DIPIVOXIL (ADV) THERAPY IN CHRONIC HBV INFECTION
Elizabeth Heathcote1 Lennox Jeffers2 Robert Perrillo3 Teresa Wright4
Morris Sherman5 Hamid Namini6 Shelly Xiong6 Craig James6 Victoria Ho6
John Fry6 Carol Brosgart6
1=West Division, The Toronto Hospital, Toronto, Canada, USA 2=Center for
Liver Disease, University of Miami, Miami, Florida, USA 3=Gastroenterology
Department, Ochsner Medical Center, New Orleans, Louisiana, USA 4=GI Unit, San Francisco VA Medical Center, San Francisco, California, USA 5=Toronto
General Hospital, Toronto, Ontario, Canada 6=Clinical Research, Gilead
Sciences, Foster City, California, USA
Objective: To evaluate long-term safety, antiviral activity, and viral
resistance in a Phase II, open-label, extension study.
Methods: 39 patients (28 HBeAg+ and 11 precore mutants) who completed Phase II ADV studies were enrolled. Patients initially received 30 mg daily, but were dose reduced to 10 mg daily for chronic therapy. Results: At baseline, median age: 41, male: 85%, Asian: 51%, precore mutants: 28%, median HBV DNA: 8.02 log10 copies/mL (Roche PCR), median ALT: 83 IU/L. To date, 21 patients continue ADV with median duration of ADV, 88 weeks (range 4-136). Median HBV DNA reductions of 3.40 (p<0.0001, N=33) and 3.36 (p<0.0001, N=23) log10 copies/mL observed at Week 48 and 100, respectively. By Week 100, HBV DNA was undetectable (<400) in 70% of patients. Median ALT reductions of 36 (N=30) and 48 IU/L (N=22)
observed at Week 48 and 100, respectively. By Week 100, ALT normalization was seen in 19/22 (70%) patients. HBeAg seroconversion demonstrated in 6/28 (21%) HBeAg+ patients. Genotypic analysis of HBV polymerase up to 136 weeks revealed no mutations associated with ADV resistance. One patient discontinued ADV due to confirmed elevated serum creatinine level (peak: 1.4 mg/dL). No patient experienced confirmed serum phosphorus <1.5 mg/dL.
Conclusions: Sustained antiviral activity and improvement of ALT
demonstrated in both wild type and precore mutant chronic HBV patients
treated up to 136 weeks with no evidence of adefovir-related resistance.
HBeAg seroconversion demonstrated in HBeAg+ patients. Long-term treatment is not associated with treatment-limiting toxicity in majority of patients.
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