title: Maintaining remission in lamivudine-resistant patients with a virological response to adefovir add-on lamivudine after stopping lamivudine therapy.
abstract: OBJECTIVE
  We examined the durability of the virological response after discontinuing lamivudine (LVD) in chronic hepatitis B (CHB) patients with LVD-resistant hepatitis B virus (HBV), who responded to LVD plus adefovir (ADV) combination therapy, and the outcome of switching to ADV monotherapy compared to maintaining combination therapy.
  
  
  METHODS
  This study enrolled 72 patients with undetectable viral loads (≤12 IU/ml) and normal alanine aminotransferase levels after ADV add-on therapy for at least 6 months in LVD-resistant CHB patients. The enrolled patients were randomly assigned to continue with LVD-ADV combination therapy or switch to ADV monotherapy (n = 36 per group). Virological rebound was defined as HBV DNA detection at more than 12 IU/ml by quantitative polymerase chain reaction determined on two consecutive measurements.
  
  
  RESULTS
  During 96 weeks of follow-up, 100% (36/36) of the patients in the LVD-ADV combination maintained group had persistently undetectable HBV DNA, compared with 94.4% (34/36) patients in the ADV monotherapy switched group. These two patients had undetectable HBV DNA after switching back to LVD-ADV combination therapy. There were no significant differences in the HBsAg levels between the two treatment groups during the 96-week follow-up period.
  
  
  CONCLUSIONS
  In our study, switching to ADV monotherapy resulted in sustained HBV DNA suppression in 94.4% of the patients for 96 weeks. Prior complete viral suppression with LVD-ADV combination therapy conferred a significant advantage in patients who switched to ADV monotherapy. LVD may be discontinued in patients who show a complete virological response to LVD-ADV combination therapy for at least 6 months.
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea; Liver Cirrhosis Clinical Research Center, Seoul, Korea.
authors: Mi Na
authors: MN
authors: Kim
authors: Chun Kyon
authors: CK
authors: Lee
authors: Sang Hoon
authors: SH
authors: Ahn
authors: Sangheun
authors: S
authors: Lee
authors: Seung Up
authors: SU
authors: Kim
authors: Do Young
authors: DY
authors: Kim
authors: Hyon Suk
authors: HS
authors: Kim
authors: Kwang-Hyub
authors: KH
authors: Han
authors: Chae Yoon
authors: CY
authors: Chon
authors: Jun Yong
authors: JY
authors: Park
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral / Q000235:genetics*; D004359:Drug Therapy, Combination; D006509:Hepatitis B / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000209:etiology; D063065:Organophosphonates / Q000627:therapeutic use*; D016133:Polymerase Chain Reaction; D016896:Treatment Outcome; D014463:Ultrasonography; D019562:Viral Load / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D063065:Organophosphonates; D019259:Lamivudine; C053001:adefovir; D000410:Alanine Transaminase; D000225:Adenine
keywords: adefovir dipivoxil; chronic hepatitis B; lamivudine; lamivudine-resistant mutation