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Clin Mol Hepatol. 2013 Mar;19(1):29-35. doi: 10.3350/cmh.2013.19.1.29. Epub 2013 Mar 25.

Antiviral efficacies of currently available rescue therapies for multidrug-resistant chronic hepatitis B.

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1
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS:

The incidence of multidrug-resistant (MDR) chronic hepatitis B (CHB) during sequential lamivudine (LAM) and adefovir dipivoxil (ADV) treatment is increasing. We investigated the antiviral efficacies of various rescue regimens in patients who failed sequential LAM-ADV treatment.

METHODS:

Forty-eight patients (83.3% of whom were HBeAg-positive) who failed sequential LAM-ADV treatment were treated with one of the following regimens: entecavir (ETV) (1 mg) monotherapy (n=16), LAM+ADV combination therapy (n=20), or ETV (1 mg)+ADV combination therapy (n=12). All patients had confirmed genotypic resistance to both LAM and ADV and were evaluated every 12 weeks.

RESULTS:

The baseline characteristics and treatment duration did not differ significantly among the study groups. During the treatment period (median duration: 100 weeks), the decline of serum HBV DNA from baseline tended to be greatest in the ETV+ADV group at all-time points (week 48: -2.55 log(10) IU/mL, week 96: -4.27 log(10) IU/mL), but the difference was not statistically significant. The ETV+ADV group also tended to have higher virologic response rates at 96 weeks compared to the ETV monotherapy or LAM+ADV groups (40.0% vs. 20.0% or 20.0%, P=0.656), and less virologic breakthrough was observed compared to the ETV monotherapy or LAM+ADV groups (8.3% vs. 37.5% or 30.0%; P=0.219), but again, the differences were not statistically significant. HBeAg loss occurred in one patient in the ETV+ADV group, in two in the ETV monotherapy group, and in none of the LAM+ADV group. The safety profiles were similar in each arm.

CONCLUSIONS:

There was a nonsignificant tendency toward better antiviral efficacy with ETV+ADV combination therapy compared to LAM+ADV combination therapy and ETV monotherapy for MDR CHB in Korea, where tenofovir is not yet available.

KEYWORDS:

Adefovir; Entecavir; Hepatitis B; Hepatitis B virus; Multidrug resistance

PMID:
23593607
PMCID:
PMC3622853
DOI:
10.3350/cmh.2013.19.1.29
[Indexed for MEDLINE]
Free PMC Article
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