Add-on adefovir is superior to a switch to entecavir as rescue therapy for lamivudine-resistant chronic Hepatitis B

Goh Eun Chung, Won Kim, Kook Lae Lee, Sang Youn Hwang, Jeong Hoon Lee, Hwi Young Kim, Yong Jin Jung, Donghee Kim, Ji Bong Jeong, Byeong Gwan Kim, Yoon Jun Kim, Jung Hwan Yoon, Hyo Suk Lee

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25 Scopus citations

Abstract

Background/Aims: Lamivudine (LAM) has been extensively used to treat hepatitis B, but high incidence of drug resistance has required rescue studies. We validated the optimum treatment strategy for LAM-resistant patients by means of a comparative study of add-on adefovir (ADV) and a switch to entecavir (ETV). Methods: We assessed the virologic response in consecutive LAM-resistant patients who received add-on ADV or a switch to ETV. Results: The mean reduction of serum hepatitis B virus (HBV) DNA levels was significantly less in the ETV group than in the add-on ADV group (-3.45 vs. -4.17; P = 0.047 at week 24 and -3.81 vs. -4.68 log10 IU/mL; P = 0.044 at week 48). Achievement of undetectable HBV DNA was significantly lower in the ETV group than in the add-on ADV group (P = 0.043). Multivariate analysis showed that add-on ADV, baseline HBV DNA levels, and initial virologic response were significant predictors of HBV DNA negativity (adjusted OR, 2.582; P = 0.008, 0.304; P = 0.001, and 5.928; P = 0.001). Virologic breakthrough was observed for 12 patients, in the ETV group only. Conclusions: Add-on ADV was more effective and durable than ETV as rescue therapy. Therefore, add-on ADV might be the preferred strategy for LAM-resistant patients who need long-term antiviral treatment.

Original languageEnglish
Pages (from-to)2130-2136
Number of pages7
JournalDigestive Diseases and Sciences
Volume56
Issue number7
DOIs
StatePublished - Jul 2011

Keywords

  • Adefovir
  • Chronic hepatitis B
  • Entecavir
  • Rescue therapy

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