Telbivudine and adefovir combination therapy for patients with chronic lamivudine-resistant hepatitis B virus infections

Abstract

We evaluated second-line salvage therapy with adefovir + telbivudine (group 1), adefovir followed by adefovir + telbivudine (group 2), or lamivudine + adefovir followed by adefovir + telbivudine (group 3) in hepatitis B patients with an inadequate virologic response to lamivudine treatment. Simple linear regression analysis showed that for each additional month of treatment, the most significant reduction in viral load occurred in group 1 (HBV DNA [Log10 IU/mL]: group 1, −0.149; group 2, -0.081; group 3, −0.123). Generalized estimating equation analysis revealed that compared to group 1, hepatitis B virus (HBV) DNA levels were 1.203 and 0.443 Log10 IU/mL higher in groups 2 and 3, respectively. Overall, a significant reduction in viral load (−0.060 Log10 IU/mL) was observed for each additional month of treatment. Adefovir + telbivudine treatment resulted in a significant reduction in HBV DNA levels. Moreover, telbivudine treatment resulted in a significant reduction in viral load (−0.050 Log10 IU/mL) compared to lamivudine treatment after the emergence of lamivudine resistance.Electronic supplementary materialThe online version of this article (doi:10.1007/s00705-013-1786-4) contains supplementary material, which is available to authorized users.

Comparison of the Efficacies and Safety of Combined Therapy between Telbivudine Plus Adefovir and Lamivudine Plus Adefovir in Patients with Hepatitis B Virus Infection in Real-World Practice

“…Chen et al [44] had the similar conclusion that prolonged combination therapy (LAM+ADV and LdT+ADV) was more effective than monotherapy (ADV), regardless of the ALT normalization rate, sustained viral response, or resistance rate. Our previous study, despite the smaller number of patients, demonstrated that LdT+ADV is a suitable second-line salvage therapy for LAM-resistant patients [45]. In our present study, we found the similar effect in terms of HBeAg seroconversion, HBV DNA undetectable rate, and/or ALT normalization rate in the LdT+ADV and LAM+ADV groups after 48 or 96 weeks of treatment ( P <0.05).…”

KASL clinical practice guidelines: management of chronic hepatitis B

“…In a small prospective study that compared an adefovir-plus-telbivudine combination-therapy group (n=21) with an adefovir-monotherapy group (n=21), the HBV undetectable rate (<300 copies/mL) was 38.5% and 0%, respectively, and adefovir resistant virus was detected in 9.6% of patients in the adefovir-monotherapy group after 96 weeks [ 294 ]. Two small prospective studies revealed that the reduction in HBV load was greater in the adefovir-plustelbivudine combination-therapy group than the adefovir-plus-lamivudine combination-therapy group [ 295 , 296 ].…”

Multiple drug-resistant HBV mutation may contribute to poor response of adefovir + entecavir in entecavir-resistant patients

“…The selection of an appropriate treatment strategy is critical for patients with chronic hepatitis B. The management of patients with HBV infection should involve a treatment that consistently reduces the viral load and prevents the development of mutations, which may result in drug resistance [26]. A number of studies have demonstrated that ADV+ETV rescue therapy is efficient for HBV patients resistant to ETV [27−30].…”