Lamivudine plus adefovir vs. entecavir in HBeAg-positive hepatitis B with sequen

StephenW

Source: Liver Int  |  Posted 6 days agoLamivudine plus adefovir vs. entecavir in HBeAg-positive hepatitis B with sequential treatment failure of lamivudine and adefovir; Son CY, Ryu HJ, Lee JM, Ahn SH, Kim DY, Lee MH, Han KH, Chon CY, Park JY; Liver International (Mar 2012)

BACKGROUND AND AIMS: Few studies have adequately examined the efficacy of lamivudine plus adefovir (LAM+ADV) combination therapy vs. entecavir (ETV) monotherapy in HBeAg-positive hepatitis B patients who fail to respond to sequential treatment with LAM and ADV. We compared directly the efficacy of LAM+ADV vs. ETV in such patients and assessed prognostic factors associated with a virologic response at month 12. METHODS: In total, 72 HBeAg-positive patients who showed resistance (n = 33) or a suboptimal virologic response (n = 39) to ADV monotherapy with resistance to LAM therapy underwent rescue therapy (31 LAM+ADV and 41 ETV). All patients were followed for at least 12 months. RESULTS: Following 12 months of treatment, in the LAM+ADV and ETV groups, a virologic response was observed in 7/31 (22.6%) and 8/41 (19.5%; P = 0.777) patients; ALT normalization occurred in 11/13 (84.6%) and 16/18 (88.9%; P = 0.566); HBeAg seroconversion in 1/31 (2.3%) and 4/41 (9.8%; P = 0.341) and a virologic breakthrough in 3/31 (9.0%) and 5/41 (12.1%; P = 0.452) respectively. Independent prognostic factors associated with a virologic response were the baseline HBV-DNA level (OR = 0.37; 95% CI 0.17-0.80; P = 0.011) and the duration of prior ADV monotherapy (OR = 0.89; 95% CI 0.83-0.95; P = 0.044). CONCLUSIONS: Neither LAM+ADV nor ETV was adequately effective in patients with sequential LAM and ADV treatment failure. Thus, when chronic hepatitis B patients show resistance or suboptimal response to ADV monotherapy, early modification of treatment should be considered.

StephenW

来源：肝Int|发表于6天前
拉米夫定加阿德福韦和恩替卡韦在HBeAg阳性乙肝拉米夫定和阿德福韦序贯治疗失败，刘某的儿子中青黄建忠，李JM，安贞焕的SH，金道溢，李氢，韩锦，公园精云，春中青国际肝病（2012年3月）

   



背景与目的：很少的研究已充分探讨拉米夫定联合阿德福韦治疗组合（林+ ADV），与恩替卡韦（ETV）HBeAg阳性慢性乙型肝炎患者未能回应与LAM和ADV序贯治疗单一的功效。我们直接比较林+ADV与ETV在这类病人的疗效和评估在12个月的病毒学应答相关的预后因素。方法：在总共72 HBeAg阳性表明
耐药
（N= 33）或一个次优的病毒学应答（N= 39）与ADV单药治疗耐林治疗的患者谁接受抢救治疗（31林+ ADV和41ETV）。所有患者随访至少12个月。结果：在LAM+ ADV和ETV组，12个月的治疗，病毒学反应，观察在7/31（22.6％）和8/41（19.5％; P=0.777）的患者ALT复常发生在11 / 13（84.6％）和16/18（88.9％，P=0.566）;在1/31（2.3％）和4/41（9.8％，P=0.341），HBeAg血清学转换和病毒学突破3/31（9.0 ％）和5/41（12.1％，P= 0.452）。与病毒学应答相关的独立预后因素，HBV-DNA的基线水平（OR= 0.37;95％CI0.17-0.80，P= 0.011）和前ADV单药治疗的持续时间（OR=0.89;95％CI为0.83-0.95; ，P =0.044）。结论：无论是林+ADV也不是ETV是充分顺序林和ADV治疗失败的患者有效。因此，慢性乙型肝炎患者显示
耐药
或ADV单药治疗的反应欠佳​​，早期治疗的修改时应该予以考虑。

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感谢分享

把握当下

拉米阿德贯序治疗失败的e抗原阳乙肝患者的后续治疗方案选择

治疗12个月：
LAM+ADV和ETV组病毒学响应率分别为22.6%和19.5%
ALT正常率分别为84.6%和88.9%
HBeAg转换率分别为2.3%和9.8%
病毒学反弹率分别为9.0%和12.1%

结论：
拉米阿德贯序治疗失败后，无论采用拉米+阿德还是恩替，效果都不够好
因此患者出现阿德单药耐药或响应不佳时，应及早修改方案




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