Tae Jung Yun, Jin Yong Jung, Chang Ha Kim, Soon Ho Um, Yeon Seok Seo, Jin Dong Kim, Hyung Joon Yim, Bora Keum, Yong Sik Kim, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Chang Duck Kim, Ho Sang Ryu, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, South Korea.
To investigate retrospectively the long-term efficacy of various treatment strategies using adefovir dipivoxil (adefovir) in patients with lamivudine-resistant chronic hepatitis B.
We included 154 consecutive patients in two treatment groups: the "add-on" group (n = 79), in which adefovir was added to ongoing lamivudine treatment due to lamivudine resistance, and the "switch/combination" group (n = 75), in which lamivudine was first switched to adefovir and then re-added later as needed. The "switch/combination" group was then divided into two subgroups depending on whether participants followed (group A, n = 30) or violated (group B, n = 45) a proposed treatment strategy that determined whether to add lamivudine based on the serum hepatitis B virus (HBV) DNA levels (< 60 IU/mL or not) after 6 mo of treatment (roadmap concept).
The cumulative probability of virologic response (HBV DNA < 60 IU/mL) was higher in group A than in the "add-on" group and in group B (P < 0.001). In contrast, the cumulative probability of virologic breakthrough was lower in the "add-on" group than in group B (P = 0.002). Furthermore, the risk of virologic breakthrough in the multivariate analysis was significantly lower in the "add-on" group than in group A (hazard ratio = 0.096; 95%CI, 0.015-0.629; P = 0.015).
The selective combination of adefovir with lamivudine based upon early treatment responses increased the odds of virologic breakthrough relative to the use of uniform combination therapy from the beginning of treatment.