The Feasibility of Discontinuing Lamivudine in Lamivudine-Resistant Chronic Hepatitis B Patients on Lamivudine and Adefovir Combination Therapy

Abstract

Objectives: This study investigated the antiviral efficacy of adefovir (ADV) rescue therapy and the feasibility of lamivudine (LAM) discontinuation in LAM-resistant chronic hepatitis B (CH-B) patients who had attained a virological response (VR) with LAM + ADV combination therapy. Methods: The VR and virological breakthrough (VBT) were analyzed in 106 consecutively enrolled LAM-resistant CH-B patients who received ADV rescue therapy during a mean follow-up period of 55.2 months. Seventy-four patients achieved VR, and were divided into the LAM-discontinuation group (n = 39) and the LAM-continuation group (n = 35). The VR and VBT between the 2 groups were compared. Results: For all 106 LAM-resistant CH-B patients, the overall cumulative probabilities of VR at 1, 2, 3 and 5 years of ADV rescue therapy were 40.6, 55.7, 64.6 and 81.3%, respectively. The cumulative probabilities of VBT at 1, 2, 3 and 5 years were 0, 2.9, 8.8 and 13.9%, respectively. Whether they discontinued or continued LAM after achieving VR on LAM + ADV therapy, VR and VBT were not significantly different during a mean follow-up period of 40.4 months. Conclusions: There was a good long-term VR with ADV rescue therapy for LAM-resistant CH-B patients. Moreover, discontinuing LAM was found to be feasible for patients who attained VR during ADV + LAM therapy.

Durability of the virological response after lamivudine discontinuation in lamivudine‐resistant patients with a complete virological response after lamivudine and adefovir combination therapy

“…During the follow‐up period (a median of 40.9 months) after LAM discontinuation, substantial patients (87.9%) showed a durable virological response. The virological relapse rate in our study is similar to that of a previous study [Chung et al, ] with a similar follow‐up duration (89.7%). Considering our use of a lower cut‐off level for the definition of a virological response (12 IU/ml) than that used by Chung et al [] (60 IU/ml), our findings might provide more reliable evidence regarding the switch to ADV monotherapy.…”

“…The virological relapse rate in our study is similar to that of a previous study [Chung et al, ] with a similar follow‐up duration (89.7%). Considering our use of a lower cut‐off level for the definition of a virological response (12 IU/ml) than that used by Chung et al [] (60 IU/ml), our findings might provide more reliable evidence regarding the switch to ADV monotherapy. Furthermore, although about 30% of our study patients had liver cirrhosis, no hepatic decompensation or HCC was documented during the follow‐up period, regardless of virological relapse.…”

“…However, the follow‐up duration of around 2 years in these studies were relatively short. Chung et al [] reported a maintenance rate of 89.7% during a mean follow‐up duration of 40.4 months.…”