Treatment strategies using adefovir dipivoxil for individuals with lamivudine-resistant chronic hepatitis B

查看全文 作　　者：Tae Jung [1]Yun;Jin Yong [1]Jung;Chang Ha [1]Kim;Soon Ho [1]Um;Hyonggin [2]An;Yeon Seok [1]Seo;Jin Dong [1]Kim;Hyung Joon [1]Yim;Bora [1]Keum;Yong Sik [1]Kim;Yoon Tae [1]Jeen;Hong Sik [1]Lee;Hoon Jai [1]Chun;Chang Duck [1]Kim;Ho Sang [1]Ryu

机构地区：[1]Department of Internal Medicine,Korea University College of Medicine,Seoul 136-705,South Korea;[2]Department of Biostatistics,Korea University College of Medicine,Seoul 136-705,South Korea

出　　处：《World Journal of Gastroenterology》索引2012年第18卷第47期,共9页

基　　金：Supported by A grant from the Korea Healthcare Technology R and D project,Ministry of Health and Welfare,South Korea,No. R06050496 摘　　要：AIM:To investigate retrospectively the long-term efficacy of various treatment strategies using adefovir dipivoxil(adefovir) in patients with lamivudine-resistant chronic hepatitis B.METHODS:We included 154 consecutive patients in two treatment groups:the 'add-on' group(n = 79),in which adefovir was added to ongoing lamivudine treatment due to lamivudine resistance,and the 'switch/combination' group(n = 75),in which lamivudine was first switched to adefovir and then re-added later as needed.The 'switch/combination' group was then divided into two subgroups depending on whether participants followed(group A,n = 30) or violated(group B,n = 45) a proposed treatment strategy that determined whether to add lamivudine based on the serum hepatitis B virus(HBV) DNA levels(< 60 IU/mL or not) after 6 mo of treatment(roadmap concept).RESULTS:The cumulative probability of virologic response(HBV DNA < 60 IU/mL) was higher in group A than in the 'add-on' group and in group B(P < 0.001).In contrast,the cumulative probability of virologic breakthrough was lower in the 'add-on' group than in group B(P = 0.002).Furthermore,the risk of virologic breakthrough in the multivariate analysis was significantly lower in the 'add-on' group than in group A(hazard ratio = 0.096;95%CI,0.015-0.629;P = 0.015).CONCLUSION:The selective combination of adefovir with lamivudine based upon early treatment responses increased the odds of virologic breakthrough relative to the use of uniform combination therapy from the beginning of treatment. 关键词：阿德福韦酯慢性乙型肝炎联合治疗拉米夫定耐药 DNA水平多变量分析病毒学

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Treatment strategies using adefovir dipivoxil for individuals with lamivudine-resistant chronic hepatitis B

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