Treatment strategies using adefovir dipivoxil for individuals with lamivudine-resistant chronic hepatitis B
- Yun, Tae Jung; Jung, Jin Yong; Kim, Chang Ha; Um, Soon Ho; An, Hyonggin; Seo, Yeon Seok; Kim, Jin Dong; Yim, Hyung Joon; Keum, Bora; Kim, Yong Sik; Jeen, Yoon Tae; Lee, Hong Sik; Chun, Hoon Jai; Kim, Chang Duck; Ryu, Ho Sang
- Issue Date
- BAISHIDENG PUBLISHING GROUP INC
- Chronic hepatitis B; Lamivudine-resistant; Adefovir; Combination therapy; Roadmap concept
- WORLD JOURNAL OF GASTROENTEROLOGY, v.18, no.47, pp.6987 - 6995
- Journal Title
- WORLD JOURNAL OF GASTROENTEROLOGY
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- AIM: To investigate retrospectively the long-term efficacy of various treatment strategies using adefovir dipivoxil (adefovir) in patients with lamivudine-resistant chronic hepatitis B. METHODS: We included 154 consecutive patients in two treatment groups: the "add-on" group (n = 79), in which adefovir was added to ongoing lamivudine treatment due to lamivudine resistance, and the "switch/combination" group (n = 75), in which lamivudine was first switched to adefovir and then re-added later as needed. The "switch/combination" group was then divided into two subgroups depending on whether participants followed (group A, n = 30) or violated (group B, n = 45) a proposed treatment strategy that determined whether to add lamivudine based on the serum hepatitis B virus (HBV) DNA levels (< 60 IU/mL or not) after 6 mo of treatment (roadmap concept). RESULTS: The cumulative probability of virologic response (HBV DNA < 60 IU/mL) was higher in group A than in the "add-on" group and in group B (P < 0.001). In contrast, the cumulative probability of virologic breakthrough was lower in the "add-on" group than in group B (P = 0.002). Furthermore, the risk of virologic breakthrough in the multivariate analysis was significantly lower in the "add-on" group than in group A (hazard ratio = 0.096; 95% CI, 0.015-0.629; P = 0.015). CONCLUSION: The selective combination of adefovir with lamivudine based upon early treatment responses increased the odds of virologic breakthrough relative to the use of uniform combination therapy from the beginning of treatment. (C) 2012 Baishideng. All rights reserved.
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- 5. Others > Others(Medicine) > 1. Journal Articles
- 1. Basic Science > Department of Biostatistics > 1. Journal Articles
- 2. Clinical Science > Department of Gastroenterology and Hepatology > 1. Journal Articles
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