PURPOSE: We and others have reported that adding adefovir dipivoxil (adefovir) to lamivudine results in virological and biochemical improvement in cases of lamivudine resistance. The current study assessed the efficacy and safety of combined therapy after 104 weeks of combined treatment and analyzed the frequency of persistent lamivudine resistant HBV. METHODS: A total of 78 patients with compensated CHB (Group A) were maintained on either adefovir 10 mg daily (n = 38) or placebo (n = 40) while continuing lamivudine. An additional 38 patients with decompensated cirrhosis or post liver transplantation (Group B) receivedlamivudine plus adefovir. The primary endpoint was HBV DNA response at year 2. RESULTS: At week 104 of therapy, a significantly greater proportion of patients in Group A on combination therapy (76%) had a decline in serum HBV DNA to ≤10(5) copies or >2 log(10) reduction from baseline compared to those receiving lamivudine alone (13%; p < 0.001). Fifty-two percent of Group A patients on combination treatment continued to have the M204V/I HBV mutation compared to 92% receiving lamivudine alone (p = 0.0013). Virologic response occurred less frequently in patients expressing persistent lamivudine resistant HBV. In Group B, 87% of patients had HBV DNA response at week 104 (median change from baseline of -5.84 log(10) copies/mL). CONCLUSIONS: The combination of lamivudine and adefovir for 2 years generally proved effective in lamivudine-resistant cases, but there was a persistently high rate of detection of lamivudine resistant mutants and impaired virologic response in compensated patients.
RCT Entities:
PURPOSE: We and others have reported that adding adefovir dipivoxil (adefovir) to lamivudine results in virological and biochemical improvement in cases of lamivudine resistance. The current study assessed the efficacy and safety of combined therapy after 104 weeks of combined treatment and analyzed the frequency of persistent lamivudine resistant HBV. METHODS: A total of 78 patients with compensated CHB (Group A) were maintained on either adefovir 10 mg daily (n = 38) or placebo (n = 40) while continuing lamivudine. An additional 38 patients with decompensated cirrhosis or post liver transplantation (Group B) received lamivudine plus adefovir. The primary endpoint was HBV DNA response at year 2. RESULTS: At week 104 of therapy, a significantly greater proportion of patients in Group A on combination therapy (76%) had a decline in serum HBV DNA to ≤10(5) copies or >2 log(10) reduction from baseline compared to those receiving lamivudine alone (13%; p < 0.001). Fifty-two percent of Group A patients on combination treatment continued to have the M204V/I HBV mutation compared to 92% receiving lamivudine alone (p = 0.0013). Virologic response occurred less frequently in patients expressing persistent lamivudine resistant HBV. In Group B, 87% of patients had HBV DNA response at week 104 (median change from baseline of -5.84 log(10) copies/mL). CONCLUSIONS: The combination of lamivudine and adefovir for 2 years generally proved effective in lamivudine-resistant cases, but there was a persistently high rate of detection of lamivudine resistant mutants and impaired virologic response in compensated patients.
Authors: S W Schalm; J Heathcote; J Cianciara; G Farrell; M Sherman; B Willems; A Dhillon; A Moorat; J Barber; D F Gray Journal: Gut Date: 2000-04 Impact factor: 23.059
Authors: J L Dienstag; E R Schiff; T L Wright; R P Perrillo; H W Hann; Z Goodman; L Crowther; L D Condreay; M Woessner; M Rubin; N A Brown Journal: N Engl J Med Date: 1999-10-21 Impact factor: 91.245
Authors: D Mutimer; D Pillay; P Shields; P Cane; D Ratcliffe; B Martin; S Buchan; L Boxall; K O'Donnell; J Shaw; S Hübscher; E Elias Journal: Gut Date: 2000-01 Impact factor: 23.059
Authors: C L Lai; R N Chien; N W Leung; T T Chang; R Guan; D I Tai; K Y Ng; P C Wu; J C Dent; J Barber; S L Stephenson; D F Gray Journal: N Engl J Med Date: 1998-07-09 Impact factor: 91.245
Authors: Robert Perrillo; Hie-Won Hann; David Mutimer; Bernard Willems; Nancy Leung; William M Lee; Alison Moorat; Stephen Gardner; Mary Woessner; Eric Bourne; Carol L Brosgart; Eugene Schiff Journal: Gastroenterology Date: 2004-01 Impact factor: 22.682
Authors: Marion G Peters; H w Hann Hw; Paul Martin; E Jenny Heathcote; P Buggisch; R Rubin; M Bourliere; K Kowdley; C Trepo; D f Gray Df; M Sullivan; K Kleber; R Ebrahimi; S Xiong; Carol L Brosgart Journal: Gastroenterology Date: 2004-01 Impact factor: 22.682
Authors: Eugene R Schiff; Ching-Lung Lai; Stefanos Hadziyannis; Peter Neuhaus; Norah Terrault; Massimo Colombo; Hans L Tillmann; Didier Samuel; Stefan Zeuzem; Leslie Lilly; Maria Rendina; Jean-Pierre Villeneuve; Nicole Lama; Craig James; Michael S Wulfsohn; Hamid Namini; Christopher Westland; Shelly Xiong; Gavin S Choy; Sally Van Doren; John Fry; Carol L Brosgart Journal: Hepatology Date: 2003-12 Impact factor: 17.425