High efficacy of adefovir and entecavir combination therapy in patients with nucleoside-refractory hepatitis B.
10.3350/kjhep.2012.18.1.75
- Author:
Hee Bok CHAE
1
;
Mee Jin KIM
;
Eui Geun SEO
;
Yong Hyeok CHOI
;
Hee Seung LEE
;
Joung Ho HAN
;
Soon Man YOON
;
Seon Mee PARK
;
Sei Jin YOUN
Author Information
1. Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea. hbchae@chungbuk.ac.kr
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Adefovir;
Entecavir;
Combination drug therapy;
Drug resistance;
Treatment efficacy
- MeSH:
Adenine/*analogs & derivatives/therapeutic use;
Adult;
Alanine Transaminase/blood;
Antiviral Agents/*therapeutic use;
DNA, Viral/blood;
Drug Resistance, Multiple, Viral;
Drug Therapy, Combination;
Female;
Genotype;
Guanine/*analogs & derivatives/therapeutic use;
Hepatitis B Antibodies/blood;
Hepatitis B e Antigens/blood;
Hepatitis B, Chronic/*drug therapy;
Humans;
Male;
Middle Aged;
Nucleosides/therapeutic use;
Phosphonic Acids/*therapeutic use
- From:The Korean Journal of Hepatology
2012;18(1):75-83
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Newly developed and potent antiviral agents suffer from the problem of drug resistance. Multidrug resistance is a major impediment in the treatment of patients with chronic hepatitis B (CHB). In line with American Association for the Study of Liver Diseases guidelines, adefovir dipivoxil (ADV) add-on therapy is recommended in the case of lamivudine resistance, while tenofovir disoproxil fumarate (TDF) is recommended for ADV or entecavir (ETV) resistance. TDF is currently not available in Korea. ADV+ETV combination therapy may be a viable alternative to TDF in patients with either ADV or ETV resistance. However, the efficacy of ADV+ETV combination therapy in patients with CHB and multidrug resistance is unclear. This study investigated the efficacy of ADV+ETV combination therapy in patients with multidrug resistance. METHODS: Twenty-five patients were enrolled and were administered ADV+ETV combination therapy for at least 6 months. Blood was drawn at baseline and at 3, 6, 9, and 12 months after commencing treatment, and the following blood parameters were analyzed: alanine transaminase, hepatitis B e-antigen (HBeAg), anti-hepatitis B e-antigen, and hepatitis B virus (HBV) DNA levels. The initial virological response (IVR) was defined as an HBV DNA level of <4 log10 copies/mL after 6 months of combination therapy. RESULTS: The IVR rate was 76%. The proportion of patients with a high viral load (> or =5.0 log) dropped from 76% at baseline to only 5% after 6 months of treatment. The biochemical response rate during the first 6 months was 71%. HBeAg was lost in 2 patients (10%). CONCLUSIONS: ADV+ETV combination therapy induced a good IVR in CHB patients who were refractory to more than 2 antiviral agents. This regimen may be a good alternative to TDF in Korea, where that drug is not available.
