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KMID : 0816120080110020143
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Korean Journal of Pediatric Gastroenterolology and Nutrition
2008 Volume.11 No. 2 p.143 ~ p.149
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Therapeutic Efficacy of Adefovir Dipivoxil in Korean Childrenand Adolescents with Chronic Hepatitis B who haveDeveloped Lamivudine Resistance
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Hwang Su-Kyeong
Lee Ji-Hye
Tak Won-Young
Kweon Young-Oh
Choe Byung-Ho
Kim Jung-Mi
Kim Jung-Ok
Cho Min-Hyun
Kim Young-Mi
Park Sun-Min
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Abstract
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Purpose: To estimate the long-term therapeutic efficacy and safety of adefovir dipivoxil in children and adolescents with chronic hepatitis B who have developed lamivudine resistance.
Methods: Sixteen patients (12 boys and 4 girls; ages 4.3∼20.9 years; mean age 14.2 years) with chronic hepatitis B infection resistant to lamivudine therapy received adefovir (0.3 mg/kg/day, maximal dose 10 mg) orally for at least 9 months between March 2004 and April 2008. Each patient was followed up for a mean period of 27 months (range 9∼49 months) until April 2008 at Kyungpook National University Hospital in Korea. Therapeutic responses to adefovir were evaluated at 12, 24, 36, and 48 months from the initiation of therapy using the Kaplan-Meier method. Response measurements included ALT normalization, HBV DNA negativization, 2 log10 IU/mL decrement of HBeAg titer, HBeAg loss, and HBeAg/Ab seroconversion rate.
Results: Three (18.8%) of the 16 patients treated with adefovir showed HBeAg/Ab seroconversion. Kaplan-Meier estimates of cumulative ALT normalization were 12.5% (12 months), 43.8% (24 months), 63.5% (36 months), and 92.7% (48 months), respectively. Cumulative HBV DNA negativization was 6.7%, 30.0%, 45.6%, and 78.2% at 12, 24, 36, and 48 months, respectively. Cumulative 2 log10 copies/mL decrement of HBeAg titer was 12.5%, 43.8%, 56.3%, and 86.9% at 12, 24, 36, and 48 months, respectively. Cumulative HBeAg loss and HBeAg/Ab seroconversion were 6.7% (12 months) and 22.2% (24 months), respectively.
Conclusion: The long-term therapeutic efficacy of adefovir dipivoxil was favorable in children and adolescents with chronic hepatitis B who had developed lamivudine resistance. The long-term use of adefovir should be safe in children.
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KEYWORD
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Adefovir dipivoxil, Chronic Hepatitis B, Lamivudine, Resistance, Children, Adolescents, Mutation
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