Details der Publikation - Long-term efficacy and emergence of multidrug resistance in patients with lamivudine-refractory chronic hepatitis B treated by combination therapy with adefovir plus lamivudine

Long-term efficacy and emergence of multidrug resistance in patients with lamivudine-refractory chronic hepatitis B treated by combination therapy with adefovir plus lamivudine

Background Few studies have investigated the emergence of multidrug resistance to adefovir dipivoxil (ADV) plus lamivudine (LAM) combination therapy for patients with LAM-refractory chronic hepatitis B (CHB). In this retrospective study, we investigated the long-term clinical course of these patients with or without multidrug resistance mutations. Methods We analyzed 406 Japanese patients with LAM-refractory CHB treated with combination therapy with follow-up for a median of 5.4 (0.5–9.5) years. Multidrug resistance of hepatitis B virus (HBV) DNA was analyzed using direct sequencing or cloning methods at baseline and viral breakthrough or insufficient decline during combination therapy. Results Ratio of patients with undetectable serum HBV DNA levels (<2.6 log copies/mL) during combination therapy was 63, 72, 75, 79, 82, 80 and 85 % at years 1 through 7, respectively. Substitutions associated with multidrug resistance were identified in 11 patients (2.7 %) at baseline, and in 12 patients (3 %) during therapy. HBV DNA levels of patients with rtA181S mutation at baseline and emergence of rtA181T + rtN236T double mutation or a wide variety of mutations during combination therapy could not be suppressed. Moreover, using ultra-deep sequencing, rtA181T/V mutations were detected at baseline in 7 of 10 patients with emergent multidrug resistance during combination therapy, although 6 of these 7 patients had very low frequency (<1 %) variants. Conclusion Long-term ADV plus LAM combination therapy is effective in LAM-refractory patients. However, HBV DNA levels of the patients with multidrug resistance at baseline or during combination therapy sometimes could not achieve complete suppression or were re-elevated after a decrease..

Medienart:	E-Artikel

Erscheinungsjahr:	2013
Erschienen:	2013

Enthalten in:	Zur Gesamtaufnahme - volume:49
Enthalten in:	Journal of gastroenterology - 49(2013), 6 vom: 09. Aug., Seite 1094-1104

Sprache:	Englisch

Beteiligte Personen:	Suzuki, Fumitaka [VerfasserIn] Hosaka, Tetsuya [VerfasserIn] Suzuki, Yoshiyuki [VerfasserIn] Akuta, Norio [VerfasserIn] Sezaki, Hitomi [VerfasserIn] Hara, Tasuku [VerfasserIn] Kawamura, Yusuke [VerfasserIn] Kobayashi, Masahiro [VerfasserIn] Saitoh, Satoshi [VerfasserIn] Arase, Yasuji [VerfasserIn] Ikeda, Kenji [VerfasserIn] Kobayashi, Mariko [VerfasserIn] Watahiki, Sachiyo [VerfasserIn] Mineta, Rie [VerfasserIn] Kumada, Hiromitsu [VerfasserIn]

Links:	Volltext [lizenzpflichtig]

BKL:	44.87$jGastroenterologie
Themen:	Adefovir dipivoxil Hepatitis B virus Lamivudine Multidrug resistance Ultra-deep sequence

RVK:	RVK Klassifikation ELIB24

Anmerkungen:	© Springer Japan 2013

doi:	10.1007/s00535-013-0864-4

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	OLC210730856X

Internformat


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520			\|a Background Few studies have investigated the emergence of multidrug resistance to adefovir dipivoxil (ADV) plus lamivudine (LAM) combination therapy for patients with LAM-refractory chronic hepatitis B (CHB). In this retrospective study, we investigated the long-term clinical course of these patients with or without multidrug resistance mutations. Methods We analyzed 406 Japanese patients with LAM-refractory CHB treated with combination therapy with follow-up for a median of 5.4 (0.5–9.5) years. Multidrug resistance of hepatitis B virus (HBV) DNA was analyzed using direct sequencing or cloning methods at baseline and viral breakthrough or insufficient decline during combination therapy. Results Ratio of patients with undetectable serum HBV DNA levels (<2.6 log copies/mL) during combination therapy was 63, 72, 75, 79, 82, 80 and 85 % at years 1 through 7, respectively. Substitutions associated with multidrug resistance were identified in 11 patients (2.7 %) at baseline, and in 12 patients (3 %) during therapy. HBV DNA levels of patients with rtA181S mutation at baseline and emergence of rtA181T + rtN236T double mutation or a wide variety of mutations during combination therapy could not be suppressed. Moreover, using ultra-deep sequencing, rtA181T/V mutations were detected at baseline in 7 of 10 patients with emergent multidrug resistance during combination therapy, although 6 of these 7 patients had very low frequency (<1 %) variants. Conclusion Long-term ADV plus LAM combination therapy is effective in LAM-refractory patients. However, HBV DNA levels of the patients with multidrug resistance at baseline or during combination therapy sometimes could not achieve complete suppression or were re-elevated after a decrease.
650		4	\|a Adefovir dipivoxil
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650		4	\|a Hepatitis B virus
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650		4	\|a Multidrug resistance
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700	1		\|a Hara, Tasuku \|4 aut
700	1		\|a Kawamura, Yusuke \|4 aut
700	1		\|a Kobayashi, Masahiro \|4 aut
700	1		\|a Saitoh, Satoshi \|4 aut
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700	1		\|a Kobayashi, Mariko \|4 aut
700	1		\|a Watahiki, Sachiyo \|4 aut
700	1		\|a Mineta, Rie \|4 aut
700	1		\|a Kumada, Hiromitsu \|4 aut
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912			\|a GBV_ILN_4333
912			\|a GBV_ILN_4334
912			\|a GBV_ILN_4335
912			\|a GBV_ILN_4336
912			\|a GBV_ILN_4338
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Long-term efficacy and emergence of multidrug resistance in patients with lamivudine-refractory chronic hepatitis B treated by combination therapy with adefovir plus lamivudine

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