FWD Mail: Combos: Entecavir/Adefovir/Lam

liver411

Hi all,

Recently at our annual conference , we had some deliberations on the above drugs. Lamivudine is the fastest to act against HBV and Entecavir the slowest. It is all about the drug kinetics and the

viral load that play a battle insde the body. The virus is capable of replicating 10 to the power 11 times a day and it takes wks and months for the drug to reach anywhere near this level. Lam takes 1

wk, Adefovir 2 wks and Entecavir 3 wks to begin its action, if the initial suppresion in achieved say at the end of one month, further therapy will be of benefit. It is important to have a fast supression of the virus to begin with otherwise as the virus keeps replicating it is always going to be uphill for the drug to catch up!

The future of HBV therapy lies in cocktail therapy, as is being done  "without any guidance" by one of our list members.

>From viral kinetics it is important to remember that use of a single drug is destined to fail if the load is high, as has happened with IFN and Lam monotherapy. IFN failing and with Lam , YMDD

emerging.

Thus a combo of Lam and Famicyclovir has given very promising results. Even Lam pulse therapy has been used like steroid priming was used initially albeit Lam works in just the opposite way, this was used in people with HBV mutant ( e antigen negative, high viral load

and normal ALT) .

Bottom line is "Drug Combo"  is the future of HBV therapy, like HIV, a combination of 2-4 drugs used in sequence or combo is here to stay, with both IFN and Lam being essential components, at least for now.



Dr Sharat C Misra MD,DM, FACG



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