Institute of Digestive Disease, The Chinese University of Hong Kong; Hong Kong SAR, China.
Aliment Pharmacol Ther. 2011 Oct;34(8):972-81. doi: 10.1111/j.1365-2036.2011.04833.x. Epub 2011 Aug 24.
In chronic hepatitis B (CHB) patients, adefovir is commonly used as a rescue therapy for lamivudine resistance, but often results in incomplete virological suppression.
To study the factors predicting response to adefovir rescue, and the treatment response of tenofovir and entecavir in suboptimal responders to adefovir in CHB patients.
Chronic hepatitis B patients who took adefovir for at least 6 months for lamivudine resistance were studied. Early virological response was defined as undetectable HBV DNA at month 6. Maintained virological response was defined as undetectable HBV DNA till the last follow-up.
Among 136 patients on adefovir for 39 (5-117) months, 30 (22%) had early virological response. The 3-year cumulative probability of maintained virological response was similar between patients on adefovir monotherapy (n = 53, 57.9%) and those on combination of lamivudine and adefovir treatment (n = 83, 56.5%). The month 6 HBV DNA was the only independent factor associated with maintained virological response (adjusted hazard ratio 0.49, 95% confidence interval 0.37-0.65, P < 0.001). Twenty-six of 30 (87%) early responders and 36 of 106 (34%) non-early responders had maintained virological response on adefovir (P < 0.001). Among 106 non-early responders, 18 and 11 were switched to tenofovir and entecavir, respectively. The 1-year cumulative probability of maintained virological response was higher in patients switched to tenofovir (87.5%) than those switched to entecavir (37.5%; P = 0.048) or continued with adefovir (8.7%; P < 0.001).
In adefovir rescue for lamivudine resistance, month 6 HBV DNA predicts maintained virological response in CHB patients. Switching to tenofovir achieved best viral suppression among suboptimal responders to adefovir.
在慢性乙型肝炎（CHB）患者中，阿德福韦酯常用于拉米夫定耐药的挽救治疗，但常常导致病毒学抑制不完全。
研究阿德福韦酯挽救治疗应答的预测因素，以及在阿德福韦酯治疗应答不佳的 CHB 患者中，替诺福韦酯和恩替卡韦的治疗应答。
研究了接受阿德福韦酯治疗至少 6 个月用于拉米夫定耐药的慢性乙型肝炎患者。早期病毒学应答定义为第 6 个月时 HBV DNA 不可检测。维持病毒学应答定义为最后一次随访时 HBV DNA 不可检测。
在接受阿德福韦酯治疗 39（5-117）个月的 136 例患者中，30 例（22%）有早期病毒学应答。阿德福韦酯单药治疗组（n=53，57.9%）和拉米夫定联合阿德福韦酯治疗组（n=83，56.5%）患者的 3 年维持病毒学应答累积概率相似。第 6 个月 HBV DNA 是与维持病毒学应答相关的唯一独立因素（调整后的危险比 0.49，95%置信区间 0.37-0.65，P＜0.001）。30 例早期应答者中有 26 例（87%）和 106 例非早期应答者中有 36 例（34%）在阿德福韦酯治疗时维持病毒学应答（P＜0.001）。在 106 例非早期应答者中，18 例和 11 例分别换用替诺福韦酯和恩替卡韦。换用替诺福韦酯的患者 1 年维持病毒学应答的累积概率高于换用恩替卡韦（37.5%；P=0.048）或继续使用阿德福韦酯（8.7%；P＜0.001）的患者。
在拉米夫定耐药的阿德福韦酯挽救治疗中，第 6 个月 HBV DNA 可预测 CHB 患者的维持病毒学应答。在阿德福韦酯治疗应答不佳的患者中，换用替诺福韦酯可获得最佳病毒抑制。
