Tailoring antiviral therapy in chronic hepatitis B patients with lamivudine resistance

Adefovir plus lamivudine are more effective than adefovir alone in lamivudine‐resistant HBeAg‐ chronic hepatitis B patients: A 4‐year study

“…However, given the increased risk of developing ETV resistance in LAM‐resistant patients, 16,17 the long‐term efficacy of this strategy is unclear. Another option in ADV‐resistant patients is to increase the dose of ADV since the currently‐recommended ADV dose appears to be suboptimal in terms of antiviral efficacy 34,35 . Recent studies have suggested that increasing the dose of ADV to 20 mg/day in LAM‐resistant patients with a suboptimal response to ADV/LAM combination is both safe and effective 22 .…”

“…Another option in ADV-resistant patients is to increase the dose of ADV since the currently-recommended ADV dose appears to be suboptimal in terms of antiviral efficacy. 34,35 Recent studies have suggested that increasing the dose of ADV to 20 mg/ day in LAM-resistant patients with a suboptimal response to ADV/ LAM combination is both safe and effective. 22 However, none of these patients had genotypic resistance to ADV and it is unclear whether 20 mg/day ADV is effective in ADV-resistant mutants.…”

Personalized therapy in chronic viral hepatitis

“…A profound inhibition of viral replication is important not only to control liver disease, but also to avoid the selection of new drug resistant strains: 2/3 of the patients with HBV-DNA > 6 log 10 cp/ml at week 48 experienced ADV resistance during the follow-up (Locarnini et al, 2005) and 67% of the patients with ADV resistance failed to reach viral levels <4 log 10 cp/ml at week 24 (Fung et al, 2006). In addition, host factors might contribute to suboptimal ADV response: compliance, reduced ADV bioavailability because of inefficient pro-drug conversion to adefovir diphosphate and polymorphism of multidrug resistance-associated proteins, type 4 (MRP4) or MRP5 (Locarnini et al, 2005;Brunetto, 2007). Nevertheless, the impact of these factors in clinical practice is low whereas ADV under dosing is thought to be one major reason of suboptimal response.…”

Avoiding and managing lamivudine resistance in chronic hepatitis B: current approaches and potential strategies including pegylated interferon

“…The approaches adopted so far were reviewed, including the use of NAs and pegIFN for managing resistance once it has emerged. The optimal treatment approach for these patients is currently still under investigation; however, the ability to tailor therapeutic regimens to individual patients, a major goal in hepatitis B virus (HBV) therapy, is likely to play an important part (9)(10)(11).…”