Adding-on versus switching-to adefovir therapy in lamivudine-resistant HBeAg-neg

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Hepatology. 2007 Jan 26;45(2):307-313 [Epub ahead of print]

Adding-on versus switching-to adefovir therapy in lamivudine-resistant

HBeAg-negative chronic hepatitis B.

Rapti I, Dimou E, Mitsoula P, Hadziyannis SJ.

Department of Medicine and Liver Unit, Henry Dunant Hospital, Athens,

Greece.

We studied the long-term efficacy of adefovir dipivoxil (ADV) treatment in

42 HBeAg-negative patients with chronic hepatitis B (CHB) who had developed

genotypical lamivudine (LAM) resistance with virological and clinical

breakthroughs under long-term LAM treatment. Patients were allocated in 2

treatment groups. In the first (n = 14), LAM was switched to ADV monotherapy

whereas in the second (n = 28) ADV was added to LAM. The two groups did not

differ in patients' characteristics, all of them having HBV genotype D

infection with the precore stop codon mutation. Within 12 months from start

of ADV treatment, serum HBV DNA became nondetectable and ALT normalized in

71% and 90% of patients, respectively, with no difference between the 2

arms. Patients with baseline HBV DNA levels less than 107 copies/ml

experienced a significantly earlier and more frequent decline in serum HBV

DNA to nondetectable levels as compared with patients with greater than 107

HBV DNA copies/ml at baseline (P = 0.0013) This response has hitherto been

maintained (median treatment duration 40 months) in all patients with ADV

added to LAM, whereas virological and biochemical breakthroughs due to

development of ADV signature resistance mutations occurred in 3 of 14

patients (21%) on ADV monotherapy 15 to 18 months from start of treatment (P

= 0.0174). Conclusion: Adding ADV to LAM in HBeAg-negative CHB patients with

LAM resistance effectively suppresses HBV replication in most of them and

induces biochemical remission that can be maintained in all of them at least

for 3 years without any evidence of development of resistance to ADV.

(HEPATOLOGY 2007;45:307-313.).

PMID: 17256746 [PubMed - as supplied by publisher]

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