Kim Jeong Han, Ahn Sung Hyun, Ko Soon Young, Choe Won Hyeok, Kim Kyun-Hwan, Kwon So Young
Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Department of Pharmacology and Center for Cancer Research and Diagnostic Medicine, IBST, Konkuk University School of Medicine, Seoul, Korea.
Clin Mol Hepatol. 2016 Jun;22(2):241-9. doi: 10.3350/cmh.2015.0053. Epub 2016 Jun 15.
BACKGROUND/AIMS: Before tenofovir (TDF) become available in South Korea, combination therapy with entecavir (ETV) and adefovir (ADV) was the most potent regimen for chronic hepatitis B (CHB) patients who fail to respond to rescue therapy for drug resistance. We analyzed the efficacy of ETV-ADV combination therapy and investigated the clinical and clonal results of TDF-based rescue therapy in CHB patients refractory to this combination.
We retrospectively reviewed the medical records of CHB patients treated for up to 3 years with ETV-ADV combination therapy as a rescue therapy for drug resistance. In cases refractory to this combination, clinical and clonal analyses were performed for TDF-based rescue therapy.
The analysis was performed on 48 patients. Twelve patients achieved a virological response (VR) within 3 years. A VR was subsequently achieved in nine of the ten patients without a VR who switched to TDF monotherapy. A VR was also achieved in six of the seven patients who switched to lamivudine-TDF combination therapy, and in two of the two patients who switched to ETV-TDF combination therapy. In an in vitro susceptibility test, viral replication was detected with TDF monotherapy but not with ETV-TDF combination therapy.
The efficacy of ETV-ADV combination therapy was insufficient in CHB patients who were refractory to rescue therapy. A more potent regimen such as ETV-TDF combination therapy may be considered in such refractory cases.
背景/目的：在韩国可获得替诺福韦（TDF）之前，恩替卡韦（ETV）和阿德福韦（ADV）联合治疗是对耐药性挽救治疗无反应的慢性乙型肝炎（CHB）患者最有效的治疗方案。我们分析了ETV-ADV联合治疗的疗效，并研究了以TDF为基础的挽救治疗在对此联合治疗难治的CHB患者中的临床和克隆结果。
我们回顾性分析了接受ETV-ADV联合治疗作为耐药性挽救治疗长达3年的CHB患者的病历。对于对此联合治疗难治的病例，对以TDF为基础的挽救治疗进行临床和克隆分析。
对48例患者进行了分析。12例患者在3年内实现了病毒学应答（VR）。在未实现VR的10例患者中，有9例随后改用TDF单药治疗并实现了VR。在改用拉米夫定-TDF联合治疗的7例患者中，有6例实现了VR，在改用ETV-TDF联合治疗的2例患者中，2例均实现了VR。在体外药敏试验中，TDF单药治疗检测到病毒复制，但ETV-TDF联合治疗未检测到。
ETV-ADV联合治疗在对挽救治疗难治的CHB患者中疗效不足。在这种难治性病例中，可考虑使用更有效的治疗方案，如ETV-TDF联合治疗。
