Advances in therapy for chronic hepatitis B.
Two agents are currently approved for the treatment of chronic hepatitis B: interferon alfa and lamivudine. Each agent has inherent limitations for use in the treatment of chronic hepatitis B. Interferon alfa is effective in a small number of patients and has serious side effects that limit its tolerability. The efficacy of lamivudine is limited by the emergence of drug-resistant hepatitis B virus (HBV) mutants, restricting its utility as a long-term therapy for chronic hepatitis B. As a result, a large proportion of chronic hepatitis B patients continue to be in need of a safe and efficacious therapy. This article provides an integrated analysis of the safety and efficacy of a new nucleotide analogue, adefovir dipivoxil, based on emerging data from recent studies. The study groups include patients with hepatitis B e antigen (HBeAg)-positive and HBeAg-negative chronic hepatitis B; lamivudine-resistant patients with compensated liver disease; lamivudine-resistant patients coinfected with the human immunodeficiency virus (HIV); and lamivudine-resistant pretransplant and posttransplant patients with decompensated liver disease. Adefovir dipivoxil 10 mg/d demonstrated potent anti-HBV activity consistently across this broad range of patient populations and was well-tolerated. Adefovir dipivoxil's effects include rapid and sustained virological, serological, histological, and biochemical responses, with minimal adverse effects. Significant histological improvement was seen in all patient subgroups at 48 weeks.
Marcellin
Patrick
P
Service d' Hépatologie and INSERM 0481, Hôpital Beaujon, Clichy, France. marcelli@bichat.inserm.fr
D000225:Adenine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D006515:Hepatitis B virus / Q000187:drug effects; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D000225:Adenine; C106812:adefovir dipivoxil