Efficacy of 2years of entecavir plus adefovir therapy in patients with chronic hepatitis B who had failed on prior nucleos(t)ide analog treatment.
Entecavir (ETV) plus adefovir (ADV) combination therapy may be a promising option for chronic hepatitis B (CHB) patients who have failed on prior nucleos(t)ide analog (NA) treatment. However, the long-term efficacy and safety of this combination are not well-defined. In a single-center, retrospective study, 104 patients (mean age 31.7 years; 88.5% male) with HBV DNA >10(3)IU/mL who had received one or multiple prior NAs for ⩾ 6 months (median 44.5 months) were treated for ⩾ 24 months with ETV (0.5mg/day) plus ADV (10mg/day). Among patients with available samples, 44/90 (48.9%) had drug-resistant mutations. At 2 years, HBV DNA levels were undetectable (<12 IU/mL) in 52/104 (50.0%) patients. The mean HBV DNA level was 2.0 ± 1.2 log 10 IU/mL, and it was decreased by 3.2 ± 2.0 log 10 IU/mL from the pre-combination treatment (V0) value. The 2-year HBeAg loss rate was 14.4% (13/90), HBeAg seroconversion rate was 10.0% (9/90), and ALT normalization rate was 75%. In multivariate analyses, the prior NA treatment duration, the V0 HBV DNA level, and the HBV DNA reduction at 1 year after ETV+ADV therapy were associated with the virological response after 2 years. No patients developed renal impairment, clinical decompensation or new HCC, and no relapses of HCC or deaths occurred. Thus, 2-year rescue therapy with ETV+ADV was effective and well-tolerated in CHB patients who had previously failed on multiple NA treatments. The HBV DNA level just before ETV+ADV combination therapy and the decrease of HBV DNA at 1 year could predict the efficacy of 2 years of ETV+ADV treatment.
Department of Infectious Diseases, Southwest Hospital, The Third Military Medical University, Chongqing, China. Electronic address: wangxhke@126.com.
Xiaohong
X
Wang
Department of Infectious Diseases, Southwest Hospital, The Third Military Medical University, Chongqing, China.
Changjiang
C
Zhang
Department of Infectious Diseases, Southwest Hospital, The Third Military Medical University, Chongqing, China.
Yan
Y
Zhu
Department of Infectious Diseases, Southwest Hospital, The Third Military Medical University, Chongqing, China.
Yulin
Y
Xiong
Department of Infectious Diseases, Southwest Hospital, The Third Military Medical University, Chongqing, China.
Yuming
Y
Wang
D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D004279:DNA, Viral / Q000097:blood; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000379:methods; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D006147:Guanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D008297:Male; D063065:Organophosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
D000998:Antiviral Agents; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D063065:Organophosphonates; C413685:entecavir; D006147:Guanine; C053001:adefovir; D000410:Alanine Transaminase; D000225:Adenine
Adefovir dipivoxil; Chronic hepatitis B; Effectiveness; Entecavir; Rescue therapy; Safety