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KMID : 1188320170110010129
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Gut and Liver
2017 Volume.11 No. 1 p.129 ~ p.135
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Management of Clevudine-Resistant Chronic Hepatitis B: A Multicenter Cohort Study
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Cho Eun-Young
Yim Hyung-Joon
Jung Young-Kul
Suh Sang-Jun
Seo Yeon-Seok
Kim Ji-Hoon
Kim Hong-Soo
Lee Sae-Hwan
Ahn Sang-Hoon
Lee Jeong-Il
Jeong Sook-Hyang
Kim Jin-Wook
Lee Jin-Woo
Kim In-Hee
Kim Hyoung-Su
Park Sang-Jong
Lee Jeong-Mi
Hwang Seong-Gyu
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Abstract
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Background/Aims: Data are lacking regarding the management of chronic hepatitis B (CHB) with resistance to clevudine (CLV). This study evaluated the efficacy of different rescue therapies for CLV-resistant CHB.
Methods: Patients with CLV-resistant CHB were enrolled in the cohort, and all patients developed virologic breakthrough during CLV therapy and had confirmed-genotypic resistance to CLV (rtM204I mutation) before enrollment.
Results: Of the 107 patients, 12 received adefovir (ADV), 21 received a CLV plus ADV combination (CLV+ADV), 34 received a lamivudine plus ADV combination (LAM+ADV), and 40 received entecavir (ETV) therapy for 48 weeks. The CLV+ADV group had the lowest hepatitis B virus (HBV) DNA level (p<0.0001) and showed the greatest reduction of HBV DNA levels from baseline compared to all other groups (p=0.004) at week 48. HBV DNA was undetectable (<70 IU/mL) in 0%, 57.1%, 21.2%, and 27.5% (p=0.003) of the patients in each group, respectively, at week 48. At the end of the study, the mean alanine transaminase (ALT) level, rate of ALT normalization, and rate of hepatitis B envelope antigen loss or seroconversion did not differ between groups.
Conclusions: CLV+ADV combination therapy in patients with CLV-resistant CHB more effectively suppresses HBV replication than ETV, ADV, or LAM+ADV therapy.
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KEYWORD
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Clevudine, Resistance, Hepatitis B, chronic, Therapy
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