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Add-On Adefovir Is Superior to a Switch to Entecavir as Rescue Therapy for Lamivudine-Resistant Chronic Hepatitis B

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An Erratum to this article was published on 02 April 2011

Abstract

Background/Aims

Lamivudine (LAM) has been extensively used to treat hepatitis B, but high incidence of drug resistance has required rescue studies. We validated the optimum treatment strategy for LAM-resistant patients by means of a comparative study of add-on adefovir (ADV) and a switch to entecavir (ETV).

Methods

We assessed the virologic response in consecutive LAM-resistant patients who received add-on ADV or a switch to ETV.

Results

The mean reduction of serum hepatitis B virus (HBV) DNA levels was significantly less in the ETV group than in the add-on ADV group (−3.45 vs. −4.17; P = 0.047 at week 24 and −3.81 vs. −4.68 log10 IU/mL; P = 0.044 at week 48). Achievement of undetectable HBV DNA was significantly lower in the ETV group than in the add-on ADV group (P = 0.043). Multivariate analysis showed that add-on ADV, baseline HBV DNA levels, and initial virologic response were significant predictors of HBV DNA negativity (adjusted OR, 2.582; P = 0.008, 0.304; P = 0.001, and 5.928; P = 0.001). Virologic breakthrough was observed for 12 patients, in the ETV group only.

Conclusions

Add-on ADV was more effective and durable than ETV as rescue therapy. Therefore, add-on ADV might be the preferred strategy for LAM-resistant patients who need long-term antiviral treatment.

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Abbreviations

ADV:

Adefovir

ALT:

Alanine aminotransferase

CHB:

Chronic hepatitis B

LAM:

Lamivudine

ETV:

Entecavir

HBeAg:

Hepatitis B envelope antigen

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

IVR:

Initial virologic response

TFV:

Tenofovir

YMDD:

Tyrosine-methionine-aspartate-aspartate

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Authors and Affiliations

  1. Department of Internal Medicine, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea

    Goh Eun Chung & Donghee Kim

  2. Department of Internal Medicine, Seoul Metropolitan Government Seoul National University, Boramae Medical Center 39, Boramae Road, Dongjakgu, Seoul, 156-707, Republic of Korea

    Won Kim, Kook Lae Lee, Yong Jin Jung, Ji Bong Jeong & Byeong Gwan Kim

  3. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

    Sang Youn Hwang, Jeong-Hoon Lee, Hwi Young Kim, Yoon Jun Kim, Jung-Hwan Yoon & Hyo-Suk Lee

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  1. Goh Eun Chung
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  2. Won Kim
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  13. Hyo-Suk Lee
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Correspondence to Won Kim.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s10620-011-1690-2

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Chung, G.E., Kim, W., Lee, K.L. et al. Add-On Adefovir Is Superior to a Switch to Entecavir as Rescue Therapy for Lamivudine-Resistant Chronic Hepatitis B. Dig Dis Sci 56, 2130–2136 (2011). https://doi.org/10.1007/s10620-010-1561-2

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  • DOI: https://doi.org/10.1007/s10620-010-1561-2

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