Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
Virol J. 2009 Oct 9;6:163. doi: 10.1186/1743-422X-6-163.
Currently, there are no conclusive results on the efficacy of adefovir dipivoxil (ADV) plus lamivudine (LAM) in LAM-resistant patients with chronic hepatitis B (CHB). The aim of study was to evaluate the efficacy of rescue therapy with ADV plus LAM compared to ADV monotherapy in LAM-resistant CHB patients.
We searched PUBMED, EMBASE, Web of Science, CNKI (National Knowledge Infrastructure), VIP database, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews. Six eligible trials (442 patients in total) were included and evaluated for methodologic quality and heterogeneity. Greater virological response and lower emergence rate of ADV-associated mutants was observed in ADV plus LAM compared to ADV monotherapy (both P < 0.05). On the contrary, the rate of ALT normalization, HBeAg clearance and seroconversion were all similar between ADV plus LAM and ADV (all P > 0.05). Additionally, adding-on or switch-to ADV was both well tolerated.
The combination of ADV with LAM was superior in inhibiting HBV replication and preventing drug resistance as compared to ADV alone for LAM-resistant CHB patients.
目前，阿德福韦酯（ADV）联合拉米夫定（LAM）治疗 LAM 耐药慢性乙型肝炎（CHB）患者的疗效尚无定论。本研究旨在评估 ADV 联合 LAM 挽救治疗与 ADV 单药治疗相比在 LAM 耐药 CHB 患者中的疗效。
我们检索了 PUBMED、EMBASE、Web of Science、CNKI（国家知识基础设施）、VIP 数据库、Cochrane 对照试验中心注册库和 Cochrane 系统评价数据库。共纳入 6 项符合条件的试验（共 442 例患者），对其进行方法学质量和异质性评估。与 ADV 单药治疗相比，ADV 联合 LAM 治疗可获得更好的病毒学应答，ADV 相关耐药突变的发生率更低（均 P < 0.05）。相反，ADV 联合 LAM 和 ADV 治疗的 ALT 复常率、HBeAg 清除率和血清学转换率均相似（均 P > 0.05）。此外，加用或换用 ADV 均具有良好的耐受性。
与 ADV 单药治疗相比，ADV 联合 LAM 治疗 LAM 耐药 CHB 患者可更有效地抑制 HBV 复制，预防耐药。
