Rescue therapy with adefovir in decompensated liver cirrhosis patients with lamivudine-resistant hepatitis B virus.
10.3350/cmh.2014.20.2.168
- Author:
Hyun Young WOO
1
;
Jong Young CHOI
;
Seung Kew YOON
;
Dong Jin SUH
;
Seung Woon PAIK
;
Kwang Hyub HAN
;
Soon Ho UM
;
Byung Ik KIM
;
Heon Ju LEE
;
Mong CHO
;
Chun Kyon LEE
;
Dong Joon KIM
;
Jae Seok HWANG
Author Information
1. Department of Internal Medicine, Pusan National University College of Medicine, Pusan, Korea.
- Publication Type:Original Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
- Keywords:
Adefovir dipivoxil;
Lamivudine-resistant;
Decompensation;
Hepatitis B virus
- MeSH:
Adenine/*analogs & derivatives/therapeutic use;
Adult;
Aged;
Antiviral Agents/*therapeutic use;
Cohort Studies;
DNA, Viral/blood;
Drug Resistance, Viral;
Female;
Hepatitis B/complications/*drug therapy;
Hepatitis B e Antigens/blood;
Hepatitis B virus/genetics;
Humans;
Lamivudine/*therapeutic use;
Liver Cirrhosis/*diagnosis/etiology/mortality;
Male;
Middle Aged;
Odds Ratio;
Organophosphonates/*therapeutic use;
Retrospective Studies;
Severity of Illness Index;
Survival Rate
- From:Clinical and Molecular Hepatology
2014;20(2):168-176
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Adefovir dipivoxil (ADV) is a nucleotide analogue that is effective against lamivudine-resistant hepatitis B virus (HBV). The aim of this study was to determine the long-term clinical outcomes after ADV rescue therapy in decompensated patients infected with lamivudine-resistant HBV. METHODS: In total, 128 patients with a decompensated state and lamivudine-resistant HBV were treated with ADV at a dosage of 10 mg/day for a median of 33 months in this multicenter cohort study. RESULTS: Following ADV treatment, 86 (72.3%) of 119 patients experienced a decrease in Child-Pugh score of at least 2 points, and the overall end-stage liver disease score decreased from 16+/-5 to 14+/-10 (mean +/- SD, P<0.001) during the follow-up period. With ADV treatment, 67 patients (56.3%) had undetectable serum HBV DNA (detection limit, 0.5 pg/mL). Virologic breakthrough occurred in 38 patients (36.1%) and 9 patients had a suboptimal ADV response. The overall survival rate was 89.9% (107/119), and a suboptimal response to ADV treatment was associated with both no improvement in Child-Pugh score (> or =2 points; P=0.001) and high mortality following ADV rescue therapy (P=0.012). CONCLUSIONS: Three years of ADV treatment was effective and safe in decompensated patients with lamivudine-resistant HBV.
