KMID : 0882420090770060716
|
|
Korean Journal of Medicine 2009 Volume.77 No. 6 p.716 ~ p.722
|
|
Lamivudine and adefovir combination therapy in patients with lamivudine-resistant HBeAg-positive chronic hepatitis B
|
|
Lee Hyun-Suk
Jeon Seong-Woo Cho Chang-Min Tak Won-Young Kweon Young-Oh Kim Sung-Kook Jung Min-Kyu Choi So-Young Park Soo-Young Choi Yong-Hwan
|
|
Abstract
|
|
|
Background/Aims: This study assessed the clinical efficacy of lamivudine-adefovir combination therapy and adefovir monotherapy for 96 weeks in patients who had hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) with genotypic resistance to lamivudine.
Methods: We reviewed 134 patients who had HBeAg-positive CHB with genotypic resistance to lamivudine. We assessed liver function tests, hepatitis B virus (HBV) DNA, HBeAg, and antibody every 12 weeks after adefovir treatment. We searched for adefovir-related mutations in patients with biochemical or virologic breakthrough after adefovir treatment.
Results: Data on 34 patients receiving combination therapy and 100 patients receiving monotherapy were analyzed. After 96 weeks, 82.4% of the combination therapy and 69.0% of the monotherapy patients had normalized alanine aminotransferase (ALT) levels (p=0.132). In addition, 50.0% and 37.0% achieved undetectable HBV DNA (p=0.210), respectively, and 23.5% and 20.0% lost HBeAg (p=0.662). The combination therapy group (5.9%) showed significantly lower biochemical breakthrough than the monotherapy group (22.0%, p=0.034) and had a lower cumulative biochemical breakthrough rate (p=0.043). One patient (2.9%) receiving combination therapy and 11 patients (11.0%) receiving monotherapy developed genotypic resistance to adefovir (p=0.155). One rtA181V mutation was detected in the combination therapy group, and ten rtA181V mutations and one rtN236T mutation were detected in the monotherapy group.
Conclusions: Combination therapy had higher rates of ALT normalization, undetectable HBV DNA, and HBeAg loss and a lower rate of adefovir resistance. Monotherapy had significantly higher biochemical breakthrough and cumulative biochemical breakthrough rates than combination therapy. Therefore, combination therapy was clinically more effective than monotherapy.
|
|
KEYWORD
|
|
Lamivudine, Hepatitis B, Chronic, Adefovir, Drug resistance
|
|
FullTexts / Linksout information
|
|
|
|
Listed journal information
|
|
|
|