Rescue therapy with adefovir in decompensated liver cirrhosis patients with lamivudine-resistant hepatitis B virus

Rescue therapy with adefovir in decompensated liver cirrhosis patients with lamivudine-resistant hepatitis B virus
이헌주김병익[김병익]최종영[최종영]김동준[김동준]황재석[황재석]조몽[조몽]Hyun Young Woo[Hyun Young Woo]Seung Kew Yoon[Seung Kew Yoon]Dong Jin Suh[Dong Jin Suh]Seung Woon Paik[Seung Woon Paik]
adefovir; adenine; antivirus agent; hepatitis B(e) antigen; lamivudine; phosphonic acid derivative; virus DNA; adult; aged; analogs and derivatives; antiviral resistance; blood; clinical trial; cohort analysis; complication; female; genetics; hepatitis B; Hepatitis B virus; human; liver cirrhosis; male; middle aged; mortality; multicenter study; retrospective study; risk; severity of illness index; survival rate; Adenine; Adult; Aged; Antiviral Agents; Cohort Studies; DNA, Viral; Drug Resistance, Viral; Female; Hepatitis B; Hepatitis B e Antigens; Hepatitis B virus; Humans; Lamivudine; Liver Cirrhosis; Male; Middle Aged; Odds Ratio; Organophosphonates; Retrospective Studies; Severity of Illness Index; Survival Rate
Issue Date
Clinical and molecular hepatology, v.20, no.2, pp.168 - 176
BACKGROUND/AIMS: Adefovir dipivoxil (ADV) is a nucleotide analogue that is effective against lamivudine-resistant hepatitis B virus (HBV). The aim of this study was to determine the long-term clinical outcomes after ADV rescue therapy in decompensated patients infected with lamivudine-resistant HBV.METHODS: In total, 128 patients with a decompensated state and lamivudine-resistant HBV were treated with ADV at a dosage of 10 mg/day for a median of 33 months in this multicenter cohort study.RESULTS: Following ADV treatment, 86 (72.3%) of 119 patients experienced a decrease in Child-Pugh score of at least 2 points, and the overall end-stage liver disease score decreased from 16��5 to 14��10 (mean �� SD, P<0.001) during the follow-up period. With ADV treatment, 67 patients (56.3%) had undetectable serum HBV DNA (detection limit, 0.5 pg/mL). Virologic breakthrough occurred in 38 patients (36.1%) and 9 patients had a suboptimal ADV response. The overall survival rate was 89.9% (107/119), and a suboptimal response to ADV treatment was associated with both no improvement in Child-Pugh score (��2 points; P=0.001) and high mortality following ADV rescue therapy (P=0.012).CONCLUSIONS: Three years of ADV treatment was effective and safe in decompensated patients with lamivudine-resistant HBV.
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