Rescue therapy with adefovir in decompensated liver cirrhosis patients with lamivudine-resistant hepatitis B virus
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Background/Aims: Adefovir dipivoxil (ADV) is a nucleotide analogue that is effective against lamivudine-resistanthepatitis B virus (HBV). The aim of this study was to determine the long-term clinical outcomes after ADV rescuetherapy 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 adosage 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 2points, and the overall end-stage liver disease score decreased from 16±5 to 14±10 (mean ± SD, P<0.001) during thefollow-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. Theoverall survival rate was 89.9% (107/119), and a suboptimal response to ADV treatment was associated with both noimprovement 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.
Abstract
Background/Aims: Adefovir dipivoxil (ADV) is a nucleotide analogue that is effective against lamivudine-resistanthepatitis B virus (HBV). The aim of this study was to determine the long-term clinical outcomes after ADV rescuetherapy 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 adosage 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 2points, and the overall end-stage liver disease score decreased from 16±5 to 14±10 (mean ± SD, P<0.001) during thefollow-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. Theoverall survival rate was 89.9% (107/119), and a suboptimal response to ADV treatment was associated with both noimprovement 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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