Add-On Adefovir Is Superior to a Switch to Entecavir as Rescue Therapy for Lamivudine-Resistant Chronic Hepatitis B

作者：Chung Goh Eun; Kim Won^*; Lee Kook Lae; Hwang Sang Youn; Lee Jeong Hoon; Kim Hwi Young; Jung Yong Jin; Kim Donghee; Jeong Ji Bong; Kim Byeong Gwan; Kim Yoon Jun; Yoon Jung Hwan; Lee Hyo Suk

来源：Digestive Diseases and Sciences, 2011, 56(7): 2130-2136.

DOI：10.1007/s10620-010-1561-2

• Adefovir
• Entecavir
• Rescue therapy
• Chronic hepatitis B

Lamivudine (LAM) has been extensively used to treat hepatitis B, but high incidence of drug resistance has required rescue studies. We validated the optimum treatment strategy for LAM-resistant patients by means of a comparative study of add-on adefovir (ADV) and a switch to entecavir (ETV).
We assessed the virologic response in consecutive LAM-resistant patients who received add-on ADV or a switch to ETV.
The mean reduction of serum hepatitis B virus (HBV) DNA levels was significantly less in the ETV group than in the add-on ADV group (-3.45 vs. -4.17; P = 0.047 at week 24 and -3.81 vs. -4.68 log(10) IU/mL; P = 0.044 at week 48). Achievement of undetectable HBV DNA was significantly lower in the ETV group than in the add-on ADV group (P = 0.043). Multivariate analysis showed that add-on ADV, baseline HBV DNA levels, and initial virologic response were significant predictors of HBV DNA negativity (adjusted OR, 2.582; P = 0.008, 0.304; P = 0.001, and 5.928; P = 0.001). Virologic breakthrough was observed for 12 patients, in the ETV group only.
Add-on ADV was more effective and durable than ETV as rescue therapy. Therefore, add-on ADV might be the preferred strategy for LAM-resistant patients who need long-term antiviral treatment.

• 出版日期2011-7