Long-Term Adefovir Therapy Useful for Chronic Hepatitis B

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Long-Term Adefovir Therapy Useful for Chronic Hepatitis B

NEW YORK (Reuters Health) Jan 30 - Treatment with adefovir dipivoxil for up

to 5 years is well tolerated and provides a variety of benefits for patients

with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B, new

research shows.

Patients with HBeAg-negative chronic hepatitis B are at increased risk for

progression to cirrhosis and hepatocellular carcinoma and rarely experience

spontaneous, sustained remission. Therefore, continuous antiviral therapy is

typically required.

Early research has shown that a 48-week course of adefovir provides clinical

improvements in patients with HBeAg-negative chronic hepatitis B.

Unfortunately, these benefits disappear upon drug discontinuation. The focus

of the present study was to determine the safety and efficacy of adefovir

treatment for up to 5 years.

As reported in the December issue of Gastroenterology, Dr. Stephanos J.

Hadziyannis, from the Henry Dunant Hospital in Athens, Greece, and

colleagues assessed the clinical outcomes of 185 patients who were

randomized to receive adefovir or placebo. The duration of adefovir therapy

ranged from 48 to 240 weeks.

At 240 weeks, 67% of adefovir-treated patients had serum hepatitis B virus

(HBV) DNA levels below 1000 copies/mL and 69% of patients had achieved

normal alanine aminotransferase levels.

With long-term adefovir therapy, necroinflammation and fibrosis improved in

83% and 73% of patients, respectively. The percentage of patients with

improved fibrosis scores, relative to baseline, was directly related to the

duration of adefovir therapy, ranging from 35% after 48 weeks to 71% after

240 weeks.

After 240 weeks of therapy, the cumulative rates of HBV polymerase

mutations, virologic resistance, and clinical resistance were 29%, 20%, and

11%, respectively.

Four patients experienced mild elevations in creatinine levels, the

investigators point out.

" Treatment with adefovir dipivoxil for up to 240 weeks produces sustained

suppression of HBV DNA levels, durable normalization of ALT, and continued

improvement in liver histology, " the authors conclude.

" With its safety, durable efficacy, and delayed resistance for up to 5

years, adefovir dipivoxil is a primary therapeutic option for the treatment

of HBeAg-negative chronic hepatitis B. "

Gastroenterology 2006;131:1743-1751.

http://www.medscape.com/viewarticle/551498?src=mp

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