title: Treatment strategies using adefovir dipivoxil for individuals with lamivudine-resistant chronic hepatitis B.
abstract: OBJECTIVE
  To investigate retrospectively the long-term efficacy of various treatment strategies using adefovir dipivoxil (adefovir) in patients with lamivudine-resistant chronic hepatitis B.
  
  
  METHODS
  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 needed. The "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).
  
  
  CONCLUSIONS
  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.
authors: Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea.
authors: Tae Jung
authors: TJ
authors: Yun
authors: Jin Yong
authors: JY
authors: Jung
authors: Chang Ha
authors: CH
authors: Kim
authors: Soon Ho
authors: SH
authors: Um
authors: Hyonggin
authors: H
authors: An
authors: Yeon Seok
authors: YS
authors: Seo
authors: Jin Dong
authors: JD
authors: Kim
authors: Hyung Joon
authors: HJ
authors: Yim
authors: Bora
authors: B
authors: Keum
authors: Yong Sik
authors: YS
authors: Kim
authors: Yoon Tae
authors: YT
authors: Jeen
authors: Hong Sik
authors: HS
authors: Lee
authors: Hoon Jai
authors: HJ
authors: Chun
authors: Chang Duck
authors: CD
authors: Kim
authors: Ho Sang
authors: HS
authors: Ryu
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006515:Hepatitis B virus; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009154:Mutation; D063065:Organophosphonates / Q000627:therapeutic use*; D011336:Probability; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D000225:Adenine; C106812:adefovir dipivoxil
keywords: Adefovir; Chronic hepatitis B; Combination therapy; Lamivudine-resistant; Roadmap concept