Long-term outcomes of two rescue therapies in lamivudine-refractory patients with chronic hepatitis B: combined lamivudine and adefovir, and 1-mg entecavir

Autor: Eun Kyung Baek, Hwan Jun Cho, Hyun Woong Lee, Jae Cheol Kwon, Jong Jin Lee, Dae Geon Ahn, Hyung Joon Kim, Han Wook Chung, EunYoung Ze
Rok vydání: 2014
Předmět:
Male
viruses
Resistance
medicine.disease_cause
Chronic hepatitis B
Gastroenterology
hemic and lymphatic diseases
Adefovir
Medicine
Hepatitis B e Antigens
biology
virus diseases
Lamivudine
Alanine Transaminase
Entecavir
Middle Aged
Treatment Outcome
HBeAg
Original Article
Drug Therapy
Combination
Female
lipids (amino acids
peptides
and proteins)
medicine.drug
Adult
Hepatitis B virus
medicine.medical_specialty
Guanine
Genotype
Combination therapy
Organophosphonates
Antiviral Agents
Hepatitis B
Chronic
Internal medicine
Drug Resistance
Viral
Humans
lcsh:RC799-869
Seroconversion
Molecular Biology
Aged
Retrospective Studies
Hepatology
business.industry
Adenine
bacterial infections and mycoses
Virology
Alanine transaminase
DNA
Viral
biology.protein
lcsh:Diseases of the digestive system. Gastroenterology
business
Zdroj: Clinical and Molecular Hepatology, Vol 20, Iss 3, Pp 267-273 (2014)
Clinical and Molecular Hepatology
ISSN: 2287-285X
2287-2728
Popis: Background/Aims Adefovir (ADV) and lamivudine (LAM) combination therapy (ADV+LAM) has been a useful option for patients with LAM-resistant (LAM-r) chronic hepatitis B (CHB). However, the long-term outcomes of LAM+ADV and 1-mg entecavir (ETV) rescue therapies have still been limited. The aim of this study was to determine the long-term outcomes of these two rescue therapies. Methods Sixty patients with LAM-r CHB underwent rescue therapy with LAM+ADV (n=36) or 1-mg ETV (n=24). We determined the duration of rescue therapy, timing and type of mutation, undetectable serum hepatitis B virus (HBV) DNA by PCR (lower limitation of detection, < 140 copies/mL), biochemical response (alanine aminotransferase < 40 IU/mL), and the incidence of hepatitis B virus e antigen (HBeAg) seroconversion and virologic breakthrough. Results Baseline characteristics did not differ between the two therapy groups. The duration of rescue therapy was 56 months (range, 14-100 months) in the ADV+LAM group and 42 months (range, 12-73 months) in the ETV group (P=0.036). The cumulative rates of HBV DNA undetectability and HBeAg seroconversion up to 6 years were 88.6% and 43.0%, respectively, in the ADV+LAM group, and 45.8% and 31.8% in the ETV group. The rate of virologic breakthrough and resistance was 14.4% in the ADV+LAM group and 71.9% in the ETV group (P=0.001). Conclusions Combination of LAM and ADV therapy for up to 6 years achieved modest rates of virological suppression and resistance. ETV is not an optimal therapy because the risk of viral breakthrough to ETV increases over time.
Databáze: OpenAIRE
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