Virologic response is not durable after adefovir discontinuation in lamivudine-resistant chronic hepatitis B patients.
10.3350/kjhep.2011.17.4.261
- Author:
Young Kul JUNG
1
;
Jong Eun YEON
;
Kwang Gyun LEE
;
Eun Seok JUNG
;
Jeong Han KIM
;
Ji Hoon KIM
;
Yeon Seok SEO
;
Hyung Joon YIM
;
Sun Ho UM
;
Ho Sang RYU
;
Kwan Soo BYUN
Author Information
1. Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea. je_yeon@hotmail.com
- Publication Type:Original Article
- Keywords:
Adefovir;
Chronic hepatitis B;
Durability;
Lamivudine
- MeSH:
Adenine/*analogs & derivatives/therapeutic use;
Adult;
Antiviral Agents/*therapeutic use;
DNA, Viral/analysis;
Drug Resistance, Viral;
Female;
Follow-Up Studies;
Hepatitis B, Chronic/*drug therapy;
Humans;
Lamivudine/therapeutic use;
Male;
Middle Aged;
Phosphonic Acids/*therapeutic use;
Recurrence;
Risk Factors
- From:The Korean Journal of Hepatology
2011;17(4):261-267
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: We investigated the durability of the biochemical and virologic responses after adefovir (ADV) discontinuation in lamivudine-resistant (LMV-R) chronic hepatitis B (CHB) patients, and the outcomes of ADV discontinuation compared to that of ADV maintenance. METHODS: The indication for ADV treatment cessation was an undetectable level of hepatitis B virus (HBV) DNA documented on two occasions at least 6 months apart. All patients received additional ADV for at least 12 months after the confirmation of undetectable HBV DNA (Cobas TaqMan PCR assay, <70 copies/mL). Of 36 patients who had a sufficient ADV therapeutic effect, 19 discontinued ADV treatment, while the others maintained it. A virologic rebound was arbitrarily defined as the redetection of HBV DNA at a level higher than 105 copies/mL. RESULTS: In the ADV discontinuation group, ADV treatment and additional therapy were administered for medians of 33 months (range, 12-47 months) and 18 months, respectively. The patients were followed for a median of 12 months (range, 3-30 months) after ADV cessation. During that period, 18 of 19 patients (95%) experienced viral relapse. Viral rebound was observed in six patients (32%). However, 12 of 18 patients (67%) exhibited serum HBV DNA levels of less than 105 copies/mL. Biochemical relapses were observed in four of the six patients with viral rebound. In the ADV maintenance group, patients were treated for a median of 53 months (range, 31-85 months), and 9 patients (53%) experienced viral breakthrough. CONCLUSIONS: During short-term follow-up after ADV discontinuation, most patients (95%) exhibited viral relapse, whereas and viral breakthrough occurred in about half of patients (53%) maintained on ADV therapy. Therefore, the durability of virologic response after ADV discontinuation in LMV-R patients was unsatisfactory. In addition, and viral breakthrough was not infrequent in the ADV continuation group.
