라미부딘 내성 만성 B형 간염 환자에서의아데포비어의 치료 효과 (The Efficacy of Adefovir Dipivoxil in Chronic Hepatitis B with Lamivudine Resistance)

서지정보

· 발행기관 : 고신대학교(의대) 고신대학교 의과대학 학술지
· 수록지 정보 : 고신대학교 의과대학 학술지 / 23권 / 2호 / 36 ~ 43페이지
· 저자명 : 이지숙, 이상욱, 장리라, 한병훈, 윤병철

초록

Backgrounds/Aims : Adefovir dipivoxil(ADV) has been shown to be effective against lamivudine resistant strain of hepatitis B virus. But continuation of lamivudine therapy or switching to Adefovir dipivoxil in patients with viral breakthrough after long term lamivudine therapy are controversial. To find efficacy of adefovir dipivoxil, we retrospectively assessed clinical course after lamivudine resistance in patients who changed adefovir dipivoxil and continued lamivudine therapy.
Methods : 58 patients with lamivudine resistant HBV mutants after at least 6 months of lamivudine treatment were included in this study. 24 of the 58 patients were treated with ADV and rest of them were continued the lamivudine therapy after lamivudine resistance. The continuous lamivudine treatment group (n=34) was divided into two groups according to ALT count (ALT≧40, n=19 vs ALT<40, n=16) The clinical course and the biochemical and virological response of the switching adefovir group were compared with those of continuing lamivudine group. HBV genotypes and YMDD mutation site was anaylzed by TRUGENE HBV Genotyping.
Results : At twelve months, the levels of median serum HBV DNA and ALT was decreased and albumin was improved significantly(P<0.01) in adefovir switching group compared with lamivudine sustained group, especially ALT was elevated more than 40. There is no significant differences between adefovir switching group and lamivudine sustained group (ALT<40, n=15). This study showed that adefovir dipivoxil reduces HBV replication and improves not only biochemical markers of disease activity, but also liver function. HBV genotypes of 58 patients were all C and rtM204I/V mutant was the most common.
Conclusion : This study provides an evidence that adefovir dipivoxil can be effective in the treatment of lamivudine-resistant HBV mutants, especially ALT elevated.

영어초록

Backgrounds/Aims : Adefovir dipivoxil(ADV) has been shown to be effective against lamivudine resistant strain of hepatitis B virus. But continuation of lamivudine therapy or switching to Adefovir dipivoxil in patients with viral breakthrough after long term lamivudine therapy are controversial. To find efficacy of adefovir dipivoxil, we retrospectively assessed clinical course after lamivudine resistance in patients who changed adefovir dipivoxil and continued lamivudine therapy.
Methods : 58 patients with lamivudine resistant HBV mutants after at least 6 months of lamivudine treatment were included in this study. 24 of the 58 patients were treated with ADV and rest of them were continued the lamivudine therapy after lamivudine resistance. The continuous lamivudine treatment group (n=34) was divided into two groups according to ALT count (ALT≧40, n=19 vs ALT<40, n=16) The clinical course and the biochemical and virological response of the switching adefovir group were compared with those of continuing lamivudine group. HBV genotypes and YMDD mutation site was anaylzed by TRUGENE HBV Genotyping.
Results : At twelve months, the levels of median serum HBV DNA and ALT was decreased and albumin was improved significantly(P<0.01) in adefovir switching group compared with lamivudine sustained group, especially ALT was elevated more than 40. There is no significant differences between adefovir switching group and lamivudine sustained group (ALT<40, n=15). This study showed that adefovir dipivoxil reduces HBV replication and improves not only biochemical markers of disease activity, but also liver function. HBV genotypes of 58 patients were all C and rtM204I/V mutant was the most common.
Conclusion : This study provides an evidence that adefovir dipivoxil can be effective in the treatment of lamivudine-resistant HBV mutants, especially ALT elevated.

참고자료

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