Efficacy of Entecavir and Adefovir Combination Therapy for Patients with Lamivudine- and Entecavir-Resistant Chronic Hepatitis B

• Published in: Digestive diseases and sciences 2012-05, Vol.57 (5), p.1358-1365
• Main Authors: Jeon, Jung Won, Shin, Hyun Phil, Lee, Joung Il, Joo, Kwang Ro, Cha, Jae Myung, Park, Jae Jun, Lim, Jun Uk, Lim, Kyuseong, Kim, Sunyong
• Format: Article
• Language: English
• Subjects: Adenine - administration & dosage; Adenine - adverse effects; Adenine - analogs & derivatives; Adult; Aged; Antiviral agents; Antiviral Agents - administration & dosage; Antiviral Agents - adverse effects; Biochemistry; DNA, Viral - blood; Drug Monitoring - methods; Drug Resistance, Viral; Drug therapy; Drug Therapy, Combination - methods; Female; Gastroenterology; Guanine - administration & dosage; Guanine - adverse effects; Guanine - analogs & derivatives; Hepatitis B; Hepatitis B virus; Hepatitis B virus - drug effects; Hepatitis B virus - metabolism; Hepatitis B virus - pathogenicity; Hepatitis B, Chronic - drug therapy; Hepatitis B, Chronic - metabolism; Hepatitis B, Chronic - virology; Hepatology; Humans; Lamivudine; Lamivudine - administration & dosage; Lamivudine - adverse effects; Liver Function Tests - methods; Male; Medical colleges; Medicine; Medicine & Public Health; Middle Aged; Oncology; Organophosphonates - administration & dosage; Organophosphonates - adverse effects; Original Article; Transplant Surgery; Treatment Outcome; Viral Load - drug effects; Virus Replication - drug effects
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-011-1988-0

Background The optimal treatment of patients with chronic hepatitis B (CHB) who develop resistance to both lamivudine (LMV) and entecavir (ETV) after sequential monotherapy of LMV and ETV remains little known. Methods We evaluated the efficacy of entecavir (ETV) plus adefovir dipivoxil (ADV) combination therapy for patients with resistance to LMV and ETV. We reviewed the medical records of 12 patients, and treated all 12 patients with ETV plus ADV combination therapy for at least 18 months. Quantitative hepatitis B virus (HBV) DNA levels, serologic markers, and hepatic panel values were monitored at baseline and 3-month intervals thereafter for 18 months. Results The baseline mean serum HBV DNA level was 7.26 ± 1.11 log 10  copies/ml. The mean reductions in serum HBV DNA levels from baseline to 3, 6, 9, 12, 15, and 18 months were −1.98 ± 1.03, −2.87 ± 1.02, −3.32 ± 1.10, −3.92 ± 1.30, −4.36 ± 1.22, and −4.57 ± 1.18 log 10  copies/ml, respectively. Complete virological response (HBV DNA of