School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, 211198, China.
Int J Infect Dis. 2012 Mar;16(3):e152-8. doi: 10.1016/j.ijid.2011.11.006. Epub 2012 Jan 4.
The aim of the current study was to compare the effectiveness of adefovir dipivoxil (ADV) monotherapy with that of combination ADV and lamivudine (LAM) therapy in the treatment of LAM-resistant chronic hepatitis B (CHB).
Publications on the effectiveness of ADV monotherapy versus the combination of ADV and LAM therapy for the treatment of LAM-resistant CHB were identified by a search (up to year 2010) of the PubMed, HealthStar, ScienceDirect, and VIP databases. Biochemical response data (alanine aminotransferase normalization rate) and virological response data (serum hepatitis B virus DNA undetectable rate) were extracted and combined to obtain an integrated result.
The literature search yielded 11 articles, six of which reported randomized controlled trials; the remaining five reported prospective cohort studies. The summary odds ratio (OR) values of the biochemical response at 3, 6, 12, and >12 months were 1.60 (p=0.06), 1.30 (p=0.18), 1.77 (p=0.008), and 3.35 (p<0.00001), respectively. The summary OR values of the virological response at 3, 6, 12, and >12 months were 1.46 (p=0.21), 1.68 (p=0.04), 1.16 (p=0.54), and 1.87 (p=0.01), respectively.
The effectiveness of the combination therapy was not obviously predominant over the monotherapy in short duration therapies; however, the combination therapy had a great advantage over monotherapy in both biochemical and virological response when the therapy duration was prolonged to >12 months.
本研究旨在比较阿德福韦酯(ADV)单药治疗与阿德福韦酯联合拉米夫定(LAM)治疗拉米夫定耐药慢性乙型肝炎(CHB)的疗效。
通过检索 PubMed、HealthStar、ScienceDirect 和 VIP 数据库(截至 2010 年),确定阿德福韦酯单药治疗与阿德福韦酯联合拉米夫定治疗拉米夫定耐药 CHB 的疗效的相关研究。提取并合并生化应答数据(丙氨酸氨基转移酶正常化率)和病毒学应答数据(血清乙型肝炎病毒 DNA 不可检测率),以获得综合结果。
文献检索共获得 11 篇文章,其中 6 篇为随机对照试验,5 篇为前瞻性队列研究。3、6、12 和>12 个月时的生化应答汇总优势比(OR)值分别为 1.60(p=0.06)、1.30(p=0.18)、1.77(p=0.008)和 3.35(p<0.00001)。3、6、12 和>12 个月时的病毒学应答汇总 OR 值分别为 1.46(p=0.21)、1.68(p=0.04)、1.16(p=0.54)和 1.87(p=0.01)。
在短期治疗中,联合治疗的效果并不明显优于单药治疗;然而,当治疗时间延长至>12 个月时,联合治疗在生化和病毒学应答方面均优于单药治疗。