Treatment strategies using adefovir dipivoxil for individuals with lamivudine-resistant chronic hepatitis B

作     者：Tae Jung Yun Jin Yong Jung Chang Ha Kim Soon Ho Um Hyonggin An Yeon Seok Seo Jin Dong Kim Hyung Joon Yim Bora Keum Yong Sik Kim Yoon Tae Jeen Hong Sik Lee Hoon Jai Chun Chang Duck Kim Ho Sang Ryu 

作者机构：Department of Internal MedicineKorea University College of MedicineSeoul 136-705South Korea Department of BiostatisticsKorea University College of MedicineSeoul 136-705South Korea 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2012年第18卷第47期

页      面：6987-6995页

核心收录：

学科分类：1004[医学-公共卫生与预防医学(可授医学、理学学位)] 100401[医学-流行病与卫生统计学] 10[医学] 

基　　金：Supported by A grant from the Korea Healthcare Technology R and D project Ministry of Health and Welfare South Korea No. R06050496 

主　　题：Chronic hepatitis B Lamivudine-resistant Adefovir Combination therapy Roadmap concept 

摘      要：AIM:To investigate retrospectively the long-term efficacy of various treatment strategies using adefovir dipivoxil(adefovir) in patients with lamivudine-resistant chronic hepatitis ***: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 *** 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.