title: Prolonged Combination Therapy is More Effective than Monotherapy in Management of Chronic Hepatitis B Patients With Sustained Virological Response: An Experience From a 'Real-World' Clinical Setting.
abstract: BACKGROUND
  Little is known about the duration of combination therapy for patients with chronic hepatitis B (CHB) and suboptimal response to nucleos(t)ide analogues(NAs) monotherapy.
  
  
  OBJECTIVE
  This study aimed to assess whether monotherapy could be used for treatment of CHB patients, who poorly responded to Adefovir Dipivoxil (ADV) but obtained good responses after at least 12-month lamivudine (LAM) or telbivudine (LdT) add-on therapy.
  
  
  METHODS
  Forty-five patients were enrolled, and the baseline time-point was determined according to enrollment data. Twenty-six patients chose to continue combination therapy (LAM+ADV or LdT+ADV, Group A) and 19 patients switched to single-drug maintenance therapy (LAM or LdT or ADV, Group B).
  
  
  RESULTS
  There were no signiﬁcant differences between two groups in baseline characteristics (P > 0.05). At 12th month, sustained virological response rate was greater in group A compared to group B (96.2% vs. 47.4%, P < 0.001), and the rates of NAs-associated resistance were 0% in group A and 15.8% in group B. Alanine aminotransferase normalization rate was also signiﬁcantly higher in group A compared with group B (92.3% vs. 36.8%, P < 0.001). Among hepatitis positive patients with Be antigen (HBeAg)-, 40% (4/10) in group A and 9.1% (1/11) in group B achieved HBeAg seroconversion at the 12th month. Of patients in group B with positive-HBeAg before the previous combination therapy and detectable HBV DNA at 6 months of previous combination therapy were associated with high risks of viral relapse after switching to single-drug maintenance therapy.
  
  
  CONCLUSIONS
  Prematurely switching to single-drug maintenance therapy would be resulted in viral relapse, and prolonged combination therapy was effective to maintain sustained responses for patients with initial suboptimal response to ADV.
authors.affiliation: Center of Infectious Diseases, West China Hospital, Sichuan University, China ; Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, China.
authors.forename: En Qiang
authors.initials: EQ
authors.lastname: Chen
authors.affiliation: Center of Infectious Diseases, West China Hospital, Sichuan University, China ; Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, China.
authors.forename: Lang
authors.initials: L
authors.lastname: Bai
authors.affiliation: Center of Infectious Diseases, West China Hospital, Sichuan University, China ; Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, China.
authors.forename: Lan Lan
authors.initials: LL
authors.lastname: Chen
authors.affiliation: Center of Infectious Diseases, West China Hospital, Sichuan University, China ; Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, China.
authors.forename: Tao You
authors.initials: TY
authors.lastname: Zhou
authors.affiliation: Center of Infectious Diseases, West China Hospital, Sichuan University, China ; Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, China.
authors.forename: Ling Yao
authors.initials: LY
authors.lastname: Du
authors.affiliation: Center of Infectious Diseases, West China Hospital, Sichuan University, China ; Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Tang
keywords: Combined Modality Therapy; Hepatitis B, Chronic; Hepatitis Be Antigens