SUMMARY: Adding Hepsera is more effective and durable than switching to Baraclude as rescue therapy for Epivir-resistant patients with chronic hepatitis B, according to a study presented in Boston last week at AASLD 2010. The mean reduction of serum HBV DNA levels was significantly less in the Entecavir group than in the add-on Hepsera group at weeks 24 and 48. In addition, the rate of undetectable HBV DNA was significantly lower in the Entecavir group than in the add-on Hepsera group.

Epivir (lamivudine; LAM) has been extensively used to treat hepatitis B but the high rate of drug resistance required rescue therapy. The aim of the current study, presented by Korean researchers at AASLD 2010 in Boston, was to validate the optimal treatment strategy for LAM-resistant patients by a head-to-head comparison between add-on adefovir (Hepsera) and a switch to entecavir (Baraclude). The investigators assessed the virologic response in consecutive LAM-resistant patients who received add-on ADV or a switch to ETV.

Results

	Ninety-six patients were enrolled and their median follow-up duration was 19.8 months.
	Fifty-two patients were included in the ETV group and 44 in the add-on ADV group.
	The mean reduction of serum HBV DNA levels was significantly less in the ETV group than the add-on ADV group at weeks 24 (P=0.047) and 48 (P=0.044).
	The rate of undetectable HBV DNA was significantly lower in the ETV group than the add-on ADV group (P=0.043).
	Multivariate analysis showed that add-on ADV, baseline HBV DNA levels, and the initial virologic response were significant predictors of HBV DNA negativity.
	Virologic breakthrough was observed for 12 patients, only in the ETV group (P=0.095).

In conclusion, the authors wrote, "Add-on ADV was more effective and durable than ETV as rescue therapy. Therefore, add-on ADV might be the preferred strategy for LAM-resistant patients who need long-term antiviral treatment."

Department of Internal Medicine and Liver Research Institute, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea, Republic of; Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea.

11/09/10

Reference
W Kim, Y Jung, and D Kim. Add-on adefovir is superior to a switch to entecavir as rescue therapy for lamivudine-resistant patients with chronic hepatitis B. 61st Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2010). Boston, October 29-November 2, 2010. Abstract 442.