Get access

Maintaining remission in lamivudine-resistant patients with a virological response to adefovir add-on lamivudine after stopping lamivudine therapy

Authors

  • Mi Na Kim,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    Search for more papers by this author
  • Chun Kyon Lee,

    1. Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
    Search for more papers by this author
  • Sang Hoon Ahn,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    Search for more papers by this author
  • Sangheun Lee,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    Search for more papers by this author
  • Seung Up Kim,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    Search for more papers by this author
  • Do Young Kim,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    Search for more papers by this author
  • Hyon Suk Kim,

    1. Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
    Search for more papers by this author
  • Kwang-Hyub Han,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    Search for more papers by this author
  • Chae Yoon Chon,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    Search for more papers by this author
  • Jun Yong Park

    Corresponding author
    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Seoul, Korea
    • Correspondence

      Jun Yong Park, MD, Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120–752, Korea

      Tel: +82 2 2228 1994

      Fax: +82 2 362 6884

      e-mail: drpjy@yuhs.ac

    Search for more papers by this author

Abstract

Background & Aims

We examined the durability of the virological response after discontinuing lamivudine (LVD) in chronic hepatitis B (CHB) patients with LVD-resistant hepatitis B virus (HBV), who responded to LVD plus adefovir (ADV) combination therapy, and the outcome of switching to ADV monotherapy compared to maintaining combination therapy.

Methods

This study enrolled 72 patients with undetectable viral loads (≤12 IU/ml) and normal alanine aminotransferase levels after ADV add-on therapy for at least 6 months in LVD-resistant CHB patients. The enrolled patients were randomly assigned to continue with LVD–ADV combination therapy or switch to ADV monotherapy (= 36 per group). Virological rebound was defined as HBV DNA detection at more than 12 IU/ml by quantitative polymerase chain reaction determined on two consecutive measurements.

Results

During 96 weeks of follow-up, 100% (36/36) of the patients in the LVD–ADV combination maintained group had persistently undetectable HBV DNA, compared with 94.4% (34/36) patients in the ADV monotherapy switched group. These two patients had undetectable HBV DNA after switching back to LVD–ADV combination therapy. There were no significant differences in the HBsAg levels between the two treatment groups during the 96-week follow-up period.

Conclusions

In our study, switching to ADV monotherapy resulted in sustained HBV DNA suppression in 94.4% of the patients for 96 weeks. Prior complete viral suppression with LVD–ADV combination therapy conferred a significant advantage in patients who switched to ADV monotherapy. LVD may be discontinued in patients who show a complete virological response to LVD–ADV combination therapy for at least 6 months.

Ancillary