title: The efficacy of adefovir plus entecavir combination therapy in patients with chronic hepatitis B refractory to both lamivudine and adefovir.
abstract: BACKGROUND
  The efficacy of adefovir (ADV) plus entecavir (ETV) combination in patients with chronic hepatitis B (CHB) who developed multidrug refractoriness had not been fully evaluated. We aimed to evaluate the efficacy of ADV plus ETV as compared to that of lamivudine (LAM) plus ADV in the patients with antiviral refractoriness to sequential LAM monotherapy and then ADV monotherapy.
  
  
  METHODS
  Twenty-seven patients were treated with a combination of ADV plus ETV and 63 patients were treated with a combination of LAM plus ADV. The virological and biochemical parameters were compared between the two groups, retrospectively.
  
  
  RESULTS
  Treatment with a combination of ADV plus ETV produced significantly superior virological response than that of a combination of LAM plus ADV. At 12 months, the HBV DNA declined more in the ADV plus ETV group than in the LAM plus ADV (-4.52 ± 1.956 vs. -2.65 ± 1.723 log 10 IU/mL; p = 0.001). The rate of a complete response at 12 months was greater in the ADV plus ETV group than that in the LAM plus ADV group (63.16 vs. 14.81 %, p < 0.001).
  
  
  CONCLUSIONS
  In the patients with CHB refractory to both LAM and ADV, the response to ADV plus ETV was significantly superior compared to that of the LAM plus ADV in suppressing HBV DNA. The result indicates that ADV plus ETV can be used as a bridging therapy in the patients with refractoriness to both LAM and ADV, especially in the areas where tenofovir is not yet available.
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Cho
authors.forename: Dong Hyeon
authors.initials: DH
authors.lastname: Lee
authors.forename: Kwang Hyun
authors.initials: KH
authors.lastname: Chung
authors.forename: Eunhyo
authors.initials: E
authors.lastname: Jin
authors.forename: Jeong-Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Cho
authors.forename: Su Jong
authors.initials: SJ
authors.lastname: Yu
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Kim
authors.forename: Sook Hyang
authors.initials: SH
authors.lastname: Jeong
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Yoon
authors.forename: Hyo-Suk
authors.initials: HS
authors.lastname: Lee
authors.forename: Chung Yong
authors.initials: CY
authors.lastname: Kim
authors.forename: Yoon Jun
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000097:blood*; D004359:Drug Therapy, Combination; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D063065:Organophosphonates; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; C053001:adefovir; D000225:Adenine