Korean J Hepatol.  2011 Dec;17(4):261-267. 10.3350/kjhep.2011.17.4.261.

Virologic response is not durable after adefovir discontinuation in lamivudine-resistant chronic hepatitis B patients

• Jung YK
• Yeon JE
• Lee KG
• Jung ES
• Kim JH
• Kim JH
• Seo YS
• Yim HJ
• Um SH
• Ryu HS
• Byun KS

• KMID: 1792604
• DOI: http://doi.org/10.3350/kjhep.2011.17.4.261

Abstract

BACKGROUND/AIMS
We investigated the durability of the biochemical and virologic responses after adefovir (ADV) discontinuation in lamivudine-resistant (LMV-R) chronic hepatitis B (CHB) patients, and the outcomes of ADV discontinuation compared to that of ADV maintenance.
METHODS
The indication for ADV treatment cessation was an undetectable level of hepatitis B virus (HBV) DNA documented on two occasions at least 6 months apart. All patients received additional ADV for at least 12 months after the confirmation of undetectable HBV DNA (Cobas TaqMan PCR assay, <70 copies/mL). Of 36 patients who had a sufficient ADV therapeutic effect, 19 discontinued ADV treatment, while the others maintained it. A virologic rebound was arbitrarily defined as the redetection of HBV DNA at a level higher than 105 copies/mL.
RESULTS
In the ADV discontinuation group, ADV treatment and additional therapy were administered for medians of 33 months (range, 12-47 months) and 18 months, respectively. The patients were followed for a median of 12 months (range, 3-30 months) after ADV cessation. During that period, 18 of 19 patients (95%) experienced viral relapse. Viral rebound was observed in six patients (32%). However, 12 of 18 patients (67%) exhibited serum HBV DNA levels of less than 105 copies/mL. Biochemical relapses were observed in four of the six patients with viral rebound. In the ADV maintenance group, patients were treated for a median of 53 months (range, 31-85 months), and 9 patients (53%) experienced viral breakthrough.
CONCLUSIONS
During short-term follow-up after ADV discontinuation, most patients (95%) exhibited viral relapse, whereas and viral breakthrough occurred in about half of patients (53%) maintained on ADV therapy. Therefore, the durability of virologic response after ADV discontinuation in LMV-R patients was unsatisfactory. In addition, and viral breakthrough was not infrequent in the ADV continuation group.

Keyword

Adefovir; Chronic hepatitis B; Durability; Lamivudine

MeSH Terms

Adenine/*analogs & derivatives/therapeutic use
Adult
Antiviral Agents/*therapeutic use
DNA, Viral/analysis
Drug Resistance, Viral
Female
Follow-Up Studies
Hepatitis B, Chronic/*drug therapy
Humans
Lamivudine/therapeutic use
Male
Middle Aged
Phosphonic Acids/*therapeutic use
Recurrence
Risk Factors