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Rescue Therapy for Lamivudine-failured Chronic Hepatitis B: Comparison Therapeutic Effect

Author: CaoLiLi
Tutor: ZhangYueXin
School: Xinjiang Medical University
Course: Internal Medicine
Keywords: Adefovir entecavir lamivudine-failured rescue treatment
CLC: R512.62
Type: Master's thesis
Year: 2011
Downloads: 49
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Abstract


Objection:Now, There have been no many reports comparing the therapeutic results of adefovir (ADV) and entecavir (ETV) rescue therapy for patients with lamivudine (LAM)-failured chronic hepatitis B (CHB). We aimed to compare the cumulative efficacy of ETV 1.0 mg monotherapy, ADV monotherapy and ADV add-on LAM combination therapy in LAM-refractory patients.Methods:One hundred and eight patients were included in the following three treatment groups; group A (n=34), LAM was switched to ETV (1.0 mg once a day); group 2 (n=20), LAM was switched to ADV (10 mg once a day); and group C (n=54), ADV was added to LAM (10 mg and 100mg once a day).Results:After 6 months of rescue treatment, alanine aminotransferase normalization was observed in58.8%、35.0% with 66.7%of patients receiving ETV monotherapy, ADV monotherapy and ADV add-on therapy, respectively. At the 12 months, the rate is 61.8%、57.9% and 76.1%.And at the 24months, alanine aminotransferase normalization was observed in 61.8%、57.9% and 76.1%, respectively.A significantly higher log10HBV-DNA drop at 6 months occurred in the ETV group with the ADV add-on group compared,and the ADV group is the lowest. The rate of HBV-DNA polymerase chain reaction undetectability (<500 copies/mL) 12 months after initiation of ETV monotherapy, ADV monotherapy and ADV add-on therapy was 52.9%、21.1%和65.2%,respectively (P=0.005). The same time,compared respectively, the rate of HBV-DNA polymerase chain reaction undetectability (<500 copies/mL) 12 months after initiation of ADV add-on therapy, ADV monotherapy was 65.2%、21.1%, respectively, (P=0.002),it was significant. The ETV monotherap is significantly higher than ADV monotherapy, the rate of HBV-DNA polymerase chain reaction undetectability (<500 copies/mL) 12 months after initiation was 52.9%、21.1%, respectively, (P=0.041).But with the ADV add-on therapy and ETV monotherapy,the rate of HBV-DNA polymerase chain reaction undetectability (<500 copies/mL) 12 months after initiation was 65.2%、52.9%, respectively (P=0.268),it was not significantly. And at the 24 months,the rate of HBV-DNA polymerase chain reaction undetectability (<500 copies/mL) after the three thearys are 46.7%、41.2%,64.7%,respectively (P=0.232). The cumulative HBeAg loss rate is not significantly difference in the three groups,47.1%、47.4% and 45.7%,respectively. Viral breakthrough and genotypic resistance were detected in 6(17.6 %)and 5(25.5%)patients in the ETV and ADV monotherapy groups, whereas there are 6(11.1%) patients were detected in ADV add-on group 24 months after initiation of antiviral treatment, (P=0.079).Conclusion:Adefovir add-on treatment and ETV monotherapy in patients with LAM-failured CHB suppresses HBV replication more effectively than ADV monotherapy,but Adefovir add-on treatment and ETV monotherapy was not significant. Additionally, the viral breakthrough rate is the lowest in the ADV add-on group.The same time,if the HBVDNA was lower than 1.0E+05Copies/ml,and ALT was higher than the normol 5 times, adjust the thearpy of anti-virus is very good.

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CLC: > Medicine, health > Internal Medicine > Infectious disease > Viral infections > Viral Hepatitis > Hepatitis B
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