Viral Hepatitis
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 14, 2007; 13(30): 4072-4079
Published online Aug 14, 2007. doi: 10.3748/wjg.v13.i30.4072
Antiviral efficacy of adefovir dipivoxil versus lamivudine in patients with chronic hepatitis B sequentially treated with lamivudine and adefovir due to lamivudine resistance
Yeon Seok Seo, Ji Hoon Kim, Jong Eun Yeon, Jong-Jae Park, Jae Seon Kim, Kwan Soo Byun, Young-Tae Bak, Chang Hong Lee
Yeon Seok Seo, Ji Hoon Kim, Jong Eun Yeon, Jong-Jae Park, Jae Seon Kim, Kwan Soo Byun, Young-Tae Bak, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
Chang Hong Lee, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Konkuk University College of Medicine, Seoul, Korea
Author contributions: All authors contributed equally to the work.
Correspondence to: Chang Hong Lee, Department of Internal Medicine, Konkuk University College of Medicine, Kwangjin-gu Hwayang-dong 1, Seoul 143-914, Korea. chlee@kuh.ac.kr
Telephone: +82-2-9206562 Fax: +82-2-9531943
Received: December 20, 2006
Revised: December 23, 2006
Accepted: January 1, 2007
Published online: August 14, 2007
Abstract

AIM: To compare the antiviral efficacy of adefovir (ADV) in lamivudine (LMV)-resistant patients with LMV treatment in nucleoside-naïve patients, using serum samples collected sequentially during the course of treatment progressing from LMV to ADV.

METHODS: Forty-four patients with chronic hepatitis B (CHB) were included. The patients were initially treated with LMV and then switched to ADV when LMV resistance developed. Antiviral efficacy was assessed by measuring the following: reduction in serum HBV DNA from baseline, HBV DNA negative conversion (defined as HBV DNA being undectable by the hybridization assay), and HBV DNA response (either HBV DNA level ≤ 105 copies/mL or a ≥ 2 log10 reduction from baseline HBV DNA level).

RESULTS: After two and six months of treatment, HBV DNA reduction was greater with LMV compared to ADV treatment (P = 0.021). HBV DNA negative conversion rates were 64% and 27% after one month of LMV and ADV treatment respectively (P = 0.001). Similarly, HBV DNA response rates were 74% and 51% after two months of LMV and ADV treatment respectively (P = 0.026).

The time taken to HBV DNA negative conversion and to HBV DNA response were both delayed in ADV treatment compared with LMV.

CONCLUSION: The antiviral efficacy of ADV in LMV-resistant patients is slower and less potent than that with LMV in nucleoside-naïve patients during the early course of treatment.

Keywords: Chronic hepatitis B; Lamivudine; Adefovir; Treatment efficacy