Rescue Therapy for Lamivudine-resistant Chronic Hepatitis B: Adefovir Monotherap

StephenW

Intern Med. <#> 2012;51(12):1509-15. Epub 2012 Jun 15.
Rescue Therapy for Lamivudine-resistant Chronic Hepatitis B: Adefovir Monotherapy, Adefovir Plus Lamivudine or Entecavir Combination Therapy.
Ha M , Zhang G, Diao S, Lin M, Wu J , Sun L, She H , Shen L, Huang C, Shen W, Huang Z.
Source
Department of Infectious Diseases and Hepatology, Shanghai 7th People's Hospital, China.
Abstract
Objective We aimed to compare the cumulative efficacy and resistance of ADV monotherapy, ADV add-on LAM (ADV + LAM), ADV and ETV (ADV + ETV) combination therapy in LAM-resistant patients. Methods Ninety-one adult CHB patients with LAM-resistance mutations (YMDD) were identified. Of these 91, 29 patients were treated with ADV monotherapy, 30 were treated with ADV + LAM and 32 were treated with ADV + ETV combination therapy, for at least 24 months. Results The mean serum HBV-DNA decreases from baseline at 3, 6, 12, and 24 months were -3.23, -4.41, -5.32, and -5.58 log<inf>10</inf>IU/mL in the ADV + ETV combination therapy groups, respectively; the most significant among the three treatment groups (p<0.01). The rate of HBV-DNA PCR undetectability (<60 IU/mL) at 6 months in ADV + ETV combination therapy was 78.1%; also the most significant among the three treatment groups (p=0.024). Viral breakthrough and genotypic mutations were detected in 8 (27.6%) and 4 (13.3%) patients in the ADV monotherapy and ADV+LAM therapy groups, respectively; whereas no case of viral breakthrough and genotypic resistance was detected in the ADV+ETV combination therapy group after 24 months (p<0.05).
Conclusion
ADV + ETV combination therapy demonstrated faster and significantly greater suppression of HBV DNA compared with ADV add-on LAM combination therapy for patients with LAM-resistance mutations. ADV + ETV was superior to ADV + LAM in achieving initial virological response and long- term suppression activity against HBV. ADV + ETV combination therapy was the most effective to refrain from selecting HBV strains with cross- resistance to three NAs (LAM, ADV and ETV) for LAM-resistance patients.

StephenW

实习生MED。 <＃> 2012年51（12）:1509-15。 EPUB 2012六月15。
抢救治疗拉米夫定耐药的慢性乙型肝炎：阿德福韦单一治疗，阿德福韦联合拉米夫定或恩替卡韦联合治疗。
厦男，张国伟，刁林茂，吴晶，孙大号，她H，沉大号，黄C，沉渭，黄Z.
源
传染病和肝病，上海市第七人民医院，中国系。
抽象
目的我们的目的是比较累计阿德福韦单药治疗的疗效和阻力，ADV添加林仪（ADV +林），ADV和ETV仪（ADV +ETV）组合林耐药患者治疗。LAM耐药突变（YMDD变异）九十一的成年慢性乙型肝炎患者的方法进行鉴定。这些91，用ADV单药治疗的29例，30例用ADV +LAM和32治疗用ADV +ETV综合疗法治疗，至少24个月。结果从基线血清HBV-DNA平均下降3，6，12和24个月分别为-3.23，-4.41，-5.32，-5.58日志<inf> 10 </ INF> IU / mL的副词+教育电视联合治疗组，分别为三个治疗组（P <0.01）之间最重要的。 ADV +ETV治疗6个月的HBV-DNA的PCR不可检测（<60 IU /毫升）率为78.1％;三个治疗组（P = 0.024）之间最重要的。 8（27.6％）和4（13.3％）患者在ADV单药治疗与ADV + LAM治疗组，分别在病毒的突破和基因型突变检测;而没有病毒的突破和基因型耐药性的情况下，ADV+ETV合24个月后治疗组（P <0.05）。
结论
ADV +ETV合治疗表现出速度更快，用ADV相比显着更大的HBV DNA抑制附加林联合治疗与LAM的耐药性突变的患者。 ADV +ETV在实现初始病毒学应答和抗HBV的长期抑制活性明显优于ADV +LAM。 ADV +ETV合治疗是最有效的避免选择三个定居的交叉耐药性乙型肝炎病毒株LAM抵抗患者（LAM，ADV和ETV）。

hzm334552863

阿德+恩替比阿德+拉米，对治疗拉米耐药患者，效果更好？

StephenW

hzm334552863 发表于 2012-7-1 11:24
阿德+恩替比阿德+拉米，对治疗拉米耐药患者，效果更好？

是.