Lamivudine and adefovir combination therapy in patients with lamivudine-resistant HBeAg-positive chronic hepatitis B / 대한내과학회지
Korean Journal of Medicine
;
: 716-722, 2009.
Article
in Korean
| WPRIM
| ID: wpr-137824
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.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
DNA
/
Drug Resistance
/
Adenine
/
Hepatitis B virus
/
Lamivudine
/
Hepatitis B, Chronic
/
Alanine Transaminase
/
Organophosphonates
/
Hepatitis B
/
Hepatitis B e Antigens
Limits:
Humans
Language:
Korean
Journal:
Korean Journal of Medicine
Year:
2009
Type:
Article
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