[503] Overlapping of Lamivudine and Adefovir Before Switching to Adefovir Monotherapy in Lamivudine Resistant Chronic Hepatitis B: Is It Necessary?

Lee, H.I.; Lee, J.H.; Tak, Won Young; Hwang, Jing‐Shiang; Bae, Seog Nyeon; Lee, T.H.; Lee, C.K.; Baik, Soon Koo; Kim, M.Y.; Park, N.H.; Ryu, S.H.; Gwak, Geum-Yon; Koh, Kwang Cheol; Paik, S.W.; Yoo, B.C.

doi:10.1016/s0168-8278(07)62101-1

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“…In order to minimize viral breakthrough with rtN236T and reA181T mutations during adefovir therapy, longer duration of overlapping adefovir-lamivudine combination therapy can be considered. Long-term combination therapy for patients with high-resistance viral load is advisable and switch to higher adefovir dosage of 20 mg daily has been reported to benefit without added renal toxicity [40][41][42][43][44][45][46]. This will be discussed in greater details in the session on adefovir dipivoxil.…”

Section: Predictors Of Lamivudine Resistance and Managementmentioning

confidence: 99%

“…First, lamivudine switched to adefovir with or without the interval of overlap is less effective when compared with lamivudine-adefovir combination therapy. This is especially so in patients with longstanding resistant HBV, high viral level, low ALT level, at either ends of the age spectrum, HBeAg positive, presence of cirrhosis, genotype non-D [42][43][44][45][46][71][72][73][74][75][76]. Addition of adefovir to ongoing lamivudine therapy is now the recommended strategy to prevent emergence of adefovirresistant mutants.…”

Section: Management Strategy For Lamivudine Resistancementioning

confidence: 99%

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Recent data on treatment of chronic hepatitis B with nucleos(t)ide analogues

Leung

2008

Hepatol Int

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Forty years ago in 1967, Professor Blumberg discovered the Australian Antigen, later known as the hepatitis B surface antigen, and was awarded the Nobel Prize. This discovery enables the diagnosis of hepatitis B virus (HBV) infection and defines its epidemiology. Viral hepatitis B infection affects global health situation, and chronic hepatitis B (CHB) is particularly serious in the Asia-Pacific region. HBV vaccines created the first breakthrough in HBV prevention. Through universal HBV vaccination program for the newborns, promoted since the mid-1980s, the main route that perpetuates chronic infection from mother to child is curbed. Most children and young adults now have immunity against HBV infection. The next breakthrough comes with therapy for CHB. This prevents progression to cirrhosis and hepatocellular carcinoma. Standard interferon therapy with modest efficacy has been largely replaced by therapy with nuclos(t)ide analogues or pegylated interferons alfa-2a and -2b. Lamivudine was approved by the FDA USA in 1998, followed by adefovir dipivoxil in 2002, entecavir in 2005, and telbivudine in 2006. Clevudine, tenofovir, and many promising candidates are in different stages of development and clinical trial. This paper critically reviews recent data published or presented since the APASL Consensus and Guideline Update of 2005. Clinical efficacy mostly in patients with raised serum alanine aminotransferase will be analyzed.

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