Ramazan Idilman is an associate member of the Turkish Academy of Sciences (TUBA).
A short course of add-on adefovir dipivoxil treatment in lamivudine-resistant chronic hepatitis B patients
Article first published online: 12 FEB 2009
© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd
Journal of Viral Hepatitis
Volume 16, Issue 4, pages 279–285, April 2009
How to Cite
Idilman, R., Kaymakoglu, S., Oguz Onder, F., Ahishali, E., Bektas, M., Cinar, K., Pınarbasi, B., Karayalcin, S., Badur, S., Cakaloglu, Y., Mithat Bozdayi, A., Bozkaya, H., Ökten, A. and Yurdaydin, C. (2009), A short course of add-on adefovir dipivoxil treatment in lamivudine-resistant chronic hepatitis B patients. Journal of Viral Hepatitis, 16: 279–285. doi: 10.1111/j.1365-2893.2009.01074.x
- Issue published online: 1 MAR 2009
- Article first published online: 12 FEB 2009
- Received July 2008; accepted for publication September 2008
- hepatitis B virus;
Summary. The aims of the study were to investigate the efficacy of rescue therapy with lamivudine (LAM) and adefovir (ADV) combination for 6 months followed by ADV monotherapy in lamivudine-resistant chronic hepatitis B (LAM-R CHB) patients, and to analyze the frequency of ADV resistance mutant development in such patients. A total of 170 consecutive LAM-R CHB patients (male/female: 130/40, mean age: 42.9 ± 13.4 years) with viral breakthrough under LAM therapy were analyzed. A total of 68 had HBeAg-positive. Patients received rescue therapy with LAM [100 mg (qd)]+ADV [10 mg (qd)] for 6 months after which LAM was discontinued. HBV-DNA was assessed with the HBV-DNA 3.0 bDNA assay. ADV-resistant mutations were identified by sequencing the reverse transcriptase region. The median duration of rescue therapy was 24 months. Cumulative probability of becoming HBV-DNA undetectable was 33.8%, 59.6% and 68.2% after 24, 48 and 96 weeks of treatment, respectively. These figures were 43.2%, 58.0% and 73.1% for ALT normalization. Among 68 HBeAg-positive CHB patients, 10 patients had an e-antigen seroconversion. Low baseline HBV-DNA level (<107 copies/mL) was a significant predictor of response to ADV treatment (P < 0.01). Cumulative probability of ADV resistance was 1.2%, 15.1% and 37.3% at 12, 24 and 36 months of therapy, respectively. By multivariate analysis, baseline high viral load and primary nonresponse to treatment at week 24 predicted ADV resistance. The data indicate that a time limited add-on strategy does not provide benefit over the switch strategy with respect emergence of ADV resistant mutants in LAM-R CHB patients.