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Virologic Responses to Add-on Adefovir Dipivoxil Treatment Versus Entecavir Monotherapy in Children With Lamivudine-resistant Chronic Hepatitis B

Chu, MiAe*; Cho, Seung Man*; Choe, Byung-Ho*; Cho, Min Hyun*; Kwon, Soonhak*; Lee, Won Kee

Journal of Pediatric Gastroenterology & Nutrition: December 2012 - Volume 55 - Issue 6 - p 648–652
doi: 10.1097/MPG.0b013e318262a737
Original Articles: Hepatology and Nutrition

Purpose: The aim of the study was to compare the virologic response to adefovir (ADV) add-on therapy with switching to entecavir (ETV) monotherapy in children and adolescents with chronic hepatitis B (CHB) who have developed lamivudine (LAM) resistance during LAM treatment.

Methods: Twenty-seven consecutive patients with CHB who had developed LAM resistance during LAM treatment were included. Of these 27 patients, 8 patients were treated with the addition of ADV to ongoing LAM and 8 patients were treated by switching to ETV monotherapy and each of these 16 patients were compared with the 11 patients who were treated by switching to ADV alone, as a historical control. Therapeutic responses to treatment were evaluated at 12, 24, 36, and 48 weeks from the initiation of therapy by measuring the decrement of hepatitis B virus (HBV)-DNA titers.

Results: The therapeutic period for HBV-DNA titer decrement (>2 log10 IU/mL) was significantly shorter in both the LAM+ADV group and the ETV group than in the ADV group (P = 0.008); however, there was no significant difference between the LAM+ADV group and the ETV group. The rate of virologic response, defined as decrement in HBV-DNA titer to undetectable levels at 24 weeks, was significantly higher in both the LAM+ADV group and the ETV group than in the ADV group (P = 0.029).

Conclusions: Both the LAM+ADV combination therapy and ETV monotherapy exhibited significantly more effective virologic responses compared to the ADV monotherapy in children and adolescents with LAM-resistant CHB, although there was no significant difference between the LAM+ADV group and the ETV group.

*Department of Pediatrics

Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, Korea.

Address correspondence and reprint requests to Byung-Ho Choe, MD, Kyungpook National University School of Medicine, Daegu, Republic of Korea (e-mail: bhchoi@knu.ac.kr).

Received 10 March, 2012

Accepted 13 May, 2012

Part of this article was presented at ASPR 2011 in Denver and it received the ASPR Best Research Award.

This research was supported by the Kyungpook National University Research Fund, 2010.

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN