Adefovir (Hepsera) for Treatment of Patients with Chronic Hepatitis B Resistant to Lamivudine (Epivir)

In a prospective cohort study, 29 participants with lamivudine-resistant HBV were treated with adefovir (Hepsera) alone, while 23 continued lamivudine and added adefovir.

Long-term successful treatment of hepatitis B virus (HBV) infection is limited by the virus' ability to develop resistance to nucleoside/nucleotide analog drugs. Lamivudine (Epivir-HBV) is among the most widely used and least expensive anti-HBV agents, but resistance is common and develops rapidly, especially when used as monotherapy.

As reported in the January 31, 2008 advance online edition of the Journal of Hepatology, Italian investigators compared treatment efficacy, factors predicting response, and HBV mutations in chronic hepatitis B patients with lamivudine resistant virus.

Results

Conclusion

"To achieve a complete virological response and reduce the risk of adefovir-resistant mutants in lamivudine-resistant patients, rescue therapy is preferable at early evidence of genotypic resistance," the authors concluded.

However, "in subjects with a significant viral load, combination therapy is more effective," they added. "The presence of the rt181 mutation is associated with incomplete response."

3/04/08

Reference

S. Gaia, V Barbon V, A Smedile, and others. Lamivudine-resistant chronic hepatitis B: an observational study on adefovir in monotherapy or in combination with lamivudine. Journal of Hepatology. January 31, 2008 [Epub ahead of print].