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Response-guided treatment of cirrhotic chronic hepatitis B patients: multicenter prospective study

Er-Li Gu1, Yi-Qi Yu1, Jia-Li Wang1

  • 1Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China.

World Journal of Gastroenterology
|January 22, 2015
PubMed

Insights

Response-guided add-on therapy with adefovir (ADV) and lamivudine (LAM) effectively suppresses hepatitis B virus (HBV) DNA and improves liver function in cirrhotic patients. This optimized treatment strategy reduces viral load and minimizes drug resistance for long-term management of chronic hepatitis B.

Area of Science:

  • Hepatology
  • Virology
  • Pharmacology

Background:

  • Chronic hepatitis B (CHB) with cirrhosis presents a significant clinical challenge.
  • Lamivudine (LAM) monotherapy is a common initial treatment, but response rates vary.
  • Adefovir (ADV) is an alternative nucleotide analog used in HBV treatment.

Purpose of the Study:

  • To evaluate the efficacy of response-guided add-on therapy with adefovir (ADV) and lamivudine (LAM) in patients with CHB and cirrhosis.
  • To assess the impact of different treatment strategies on viral suppression and YMDD mutations.
  • To determine the effect on biochemical markers and liver function.

Main Methods:

  • 100 CHB patients with cirrhosis were stratified into three groups based on HBV DNA levels after 24 weeks of LAM monotherapy.
  • ADV was added to LAM at different time points (week 24 or 48) based on the initial response.
  • Virological response, YMDD mutations, biochemical response, and liver function were monitored over 144 weeks.

Main Results:

  • Early complete virologic response at 24 weeks correlated with sustained viral suppression (95.96% undetectable HBV DNA at 144 weeks) and minimal YMDD mutations (0%).
  • For incomplete responders, combination therapy reduced HBV DNA by 1 log10 IU/mL.
  • All treatment arms showed biochemical improvements, including decreased ALT and increased albumin. ADV add-on did not induce further resistance in patients with YMDD mutations.

Conclusions:

  • Optimized response-guided add-on therapy with ADV and LAM provides long-term HBV DNA suppression in CHB patients with compensated cirrhosis.
  • This strategy effectively improves liver function and biochemical parameters.
  • The approach is valuable for managing CHB patients, minimizing resistance development.
Abstract

Keywords:
Adefovir dipivoxilCirrhosisHepatitis BLamivudineResponse-guided therapy

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