Therapeutic effect of antiviral regimens for chronic hepatitis B refractory to lamivudine plus adefovir
10.3969/j.issn.1673-4254.2013.12.25
- VernacularTitle:拉米夫定与阿德福韦酯联合治疗应答不佳的慢性乙型肝炎患者的抗病毒治疗
- Author:
Ming LI
1
;
Jingyu WU
;
Guanjun XU
;
Qin ZHANG
;
Zhiyong CHEN
;
Zhenhua LIU
Author Information
1. 九江市第三人民医院肝科
- Keywords:
hepatitis B,chronic;
lamivudine;
adefovir dipivoxil;
entecavir;
interferon
- From:
Journal of Southern Medical University
2013;(12):1823-1826
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the efficacy and safety of recombinant human interferon α-2b (INFα-2b) monotherapy and combined therapy with entecavir (ETV) plus adefovir dipivoxil (ADV) in chronic hepatitis B patients with poor response to combined therapy with lamivudine and ADV. Methods A total of 161 patients with chronic hepatitis B refractory to to combined therapy with lamivudine (LAM) and ADV were randomized to receive INFα-2b monotherapy (5 × 106, three times a week) (group A) or combined therapy with entecavir (0.5 mg/day) plus adefovir (10 mg/day) (group B). Serum levels of HBsAg, HBeAg and HBV viral load were analyzed at 48 weeks using chemiluminescence assay and by real-time PCR as appropriate. The drug resistance genes in HBV was tested by direct DNA sequencing. Results At 48 weeks of treatment, HBV DNA decreased significantly in groups A and B to 2.06 ± 1.15log10 copies/ml and 1.77 ± 1.28log10 copies/ml, respectively. The rates of viral response, serological response, and biochemical response in groups A and B were 48.15%(39/81) vs 53.75%(43/80), 61.70%(50/81) vs 53.75%(43/80), and 49.38%(40/81) vs 60.00%(48/80), showing no significant differences between the two groups (P>0.05). The drug resistance gene mutation rate was significanty higher in group B (64.86%, 24/37) than in group A (30.95%, 13/42, P<0.05). Conclusions Chronic hepatitis B patients refractory to lamivudine combined with ADV have a good response to INFα-2b monotherapy and combined therapy with entecavir and ADV , and interferon treatment is preferred to reduce potential drug resistance gene mutations.
