Comparison of the efficacy of Lamivudine plus adefovir versus entecavir in the treatment of Lamivudine-resistant chronic hepatitis B: a systematic review and meta-analysis.
BACKGROUND
Hepatitis B virus infection remains 1 of the major health threats worldwide. Currently, lamivudine plus adefovir combination therapy or entecavir monotherapy is usually used for the treatment of patients with lamivudine-resistant chronic hepatitis B (CHB). However, there are few systematic comparisons between the efficacy of lamivudine plus adefovir and the efficacy of entecavir in the treatment of these patients.


OBJECTIVE
The goal of this systematic study and meta-analysis was to assess the efficacy of lamivudine plus adefovir compared with entecavir for the treatment of patients with lamivudine-resistant CHB.


METHODS
A comprehensive literature search of PUBMED, Web of Science, WANFANG database, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Review, were screened to obtain citations from January 1990 to January 2012 in this study. Data analysis was done by using the Review Manager Software 5.1.


RESULTS
Eight studies were suitable for analysis. A total of 696 patients with lamivudine-resistant CHB were studied and grouped according to treatment: 341 patients in the entecavir group and 355 patients in the lamivudine plus adefovir group. The results found that the rates of undetectable hepatitis B virus DNA levels, alanine aminotransferase normalization, hepatitis B e antigen loss, and hepatitis B e antigen seroconversion were not significantly different between the lamivudine plus adefovir group and the entecavir group. Moreover, the rate of adverse reactions was also not significantly different between the 2 groups. However, virologic breakthrough for the patients with lamivudine resistance was higher in the entecavir group than in the lamivudine plus adefovir group.


CONCLUSIONS
For these CHB patients with lamivudine resistance, lamivudine plus adefovir was a better treatment option than entecavir alone.
Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China; Key Laboratory of Viral Hepatitis, Hunan Province, China.
Ze-Bing
ZB
Huang
Eight-year Program Student, Xiangya Hospital, Central South University, Changsha, China.
Shu-Shan
SS
Zhao
Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China; Key Laboratory of Viral Hepatitis, Hunan Province, China.
Yan
Y
Huang
State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Zhejiang University, Hangzhou, China.
Xia-Hong
XH
Dai
Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China; Key Laboratory of Viral Hepatitis, Hunan Province, China.
Rong-Rong
RR
Zhou
Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China; Key Laboratory of Viral Hepatitis, Hunan Province, China.
Pan-Pan
PP
Yi
Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China; Key Laboratory of Viral Hepatitis, Hunan Province, China.
Ruo-Chan
RC
Chen
Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China; Key Laboratory of Viral Hepatitis, Hunan Province, China.
Wen-Ting
WT
Li
Department of Infectious Diseases, Hunan Provincial Corps Hospital of Chinese, People's Armed Police Forces, Changsha, China.
Bao-Xin
BX
Zhang
Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha, China.
Ning
N
Li
Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China; Key Laboratory of Viral Hepatitis, Hunan Province, China. Electronic address: xgfan@hotmail.com.
Xue-Gong
XG
Fan
D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006515:Hepatitis B virus / Q000187:drug effects* / Q000235:genetics / Q000254:growth & development / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D063065:Organophosphonates / Q000627:therapeutic use*; D016896:Treatment Outcome
D000998:Antiviral Agents; D063065:Organophosphonates; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; C053001:adefovir; D000225:Adenine
chronic hepatitis B; entecavir; lamivudine plus adefovir; lamivudine resistance