www.hivandhepatitis.com

Add-on Adefovir Is More Effective and Durable Than Switch to Entecavir as Rescue Therapy

Adding adefovir (Hepsera) is more effective and durable than switching to entecavir (Baraclude) as rescue therapy for Epivir-resistant patients with chronic hepatitis B, according to a study presented in Boston last week at AASLD 2010. The mean reduction of serum HBV DNA levels was significantly less in the entecavir group than in the add-on adefovir group at weeks 24 and 48. In addition, the rate of undetectable HBV DNA was significantly lower in the entecavir group than in the add-on adefovir group.

Epivir (lamivudine) has been extensively used to treat hepatitis B but the high rate of drug resistance required rescue therapy. The aim of the current study, presented by Korean researchers at AASLD 2010 in Boston, was to validate the optimal treatment strategy for lamivudine-resistant patients by a head-to-head comparison between add-on adefovir and a switch to entecavir. The investigators assessed the virologic response in consecutive lamivudine-resistant patients who received add-on adefovir or a switch to entecavir.

Results

• 96 patients were enrolled and their median follow-up duration was 19.8 months.
• 52 patients were included in the entecavir group and 44 in the add-on adefovir group.
• The mean reduction of serum HBV DNA levels was significantly less in the entecavir group than the add-on adefovir group at weeks 24 (P=0.047) and 48 (P=0.044).
• The rate of undetectable HBV DNA was significantly lower in the entecavir group than the add-on adefovir group (P=0.043).
• Multivariate analysis showed that add-on adefovir, baseline HBV DNA levels, and the initial virologic response were significant predictors of HBV DNA negativity.
• Virologic breakthrough was observed for 12 patients, only in the entecavir group (P=0.095).

In conclusion, the authors wrote, "Add-on adefovir was more effective and durable than entecavir as rescue therapy. Therefore, add-on adefovir might be the preferred strategy for LAM-resistant patients who need long-term antiviral treatment."

Department of Internal Medicine and Liver Research Institute, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea, Republic of; Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea.

11/09/10

Reference

W Kim, Y Jung, and D Kim. Add-on adefovir is superior to a switch to entecavir as rescue therapy for lamivudine-resistant patients with chronic hepatitis B. 61st Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2010). Boston, October 29-November 2, 2010. Abstract 442.