Clin Mol Hepatol.
2014 Jun;20(2):168-176. 10.3350/cmh.2014.20.2.168.
Rescue therapy with adefovir in decompensated liver cirrhosis patients with lamivudine-resistant hepatitis B virus
- Affiliations
-
- 1Department of Internal Medicine, Pusan National University College of Medicine, Pusan, Korea.
- 2Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea. jychoi@catholic.ac.kr
- 3Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
- 4Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- 5Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
- 6Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
- 7Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
- 8Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
- 9Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
- 10Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
- 11Department of Internal Medicine, Keimyung University College of Medicine, Daegu, Korea.
- KMID: 1788566
- DOI: http://doi.org/10.3350/cmh.2014.20.2.168
Abstract
- BACKGROUND/AIMS
Adefovir dipivoxil (ADV) is a nucleotide analogue that is effective against lamivudine-resistant hepatitis B virus (HBV). The aim of this study was to determine the long-term clinical outcomes after ADV rescue therapy in decompensated patients infected with lamivudine-resistant HBV.
METHODS
In total, 128 patients with a decompensated state and lamivudine-resistant HBV were treated with ADV at a dosage of 10 mg/day for a median of 33 months in this multicenter cohort study.
RESULTS
Following ADV treatment, 86 (72.3%) of 119 patients experienced a decrease in Child-Pugh score of at least 2 points, and the overall end-stage liver disease score decreased from 16+/-5 to 14+/-10 (mean +/- SD, P<0.001) during the follow-up period. With ADV treatment, 67 patients (56.3%) had undetectable serum HBV DNA (detection limit, 0.5 pg/mL). Virologic breakthrough occurred in 38 patients (36.1%) and 9 patients had a suboptimal ADV response. The overall survival rate was 89.9% (107/119), and a suboptimal response to ADV treatment was associated with both no improvement in Child-Pugh score (> or =2 points; P=0.001) and high mortality following ADV rescue therapy (P=0.012).
CONCLUSIONS
Three years of ADV treatment was effective and safe in decompensated patients with lamivudine-resistant HBV.
MeSH Terms
-
Adenine/*analogs & derivatives/therapeutic use
Adult
Aged
Antiviral Agents/*therapeutic use
Cohort Studies
DNA, Viral/blood
Drug Resistance, Viral
Female
Hepatitis B/complications/*drug therapy
Hepatitis B e Antigens/blood
Hepatitis B virus/genetics
Humans
Lamivudine/*therapeutic use
Liver Cirrhosis/*diagnosis/etiology/mortality
Male
Middle Aged
Odds Ratio
Organophosphonates/*therapeutic use
Retrospective Studies
Severity of Illness Index
Survival Rate
Adenine
Antiviral Agents
DNA, Viral
Hepatitis B e Antigens
Lamivudine
Organophosphonates
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