Sequential treatment with entecavir and lamivudine results in rebound of hepatitis B virus

Mar 31, 2011

A two-year trial of entecavir followed by lamivudine (LAM) in patients with chronic hepatitis B virus (HBV) infection resulted in a virologic rebound rate of 24% and 12% drug-resistance rate. Patients who continued on entecavir therapy throughout the study period had undetectable HBV DNA at the two-year endpoint. Details of this trial are published in the April issue of Hepatology, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases.

The World Health Organization (WHO) estimates that more than 2 billion people worldwide have been infected with HBV; roughly 360 million of these cases are chronic infection that could lead to and hepatocelluar carcinoma (). LAM is the first oral antiviral agent available to treat chronic HBV infection by inhibiting disease progression. However, a 2007 study by Yuen et al. determined that long-term treatment with LAM is associated with a 76% drug-resistance rate after eight years. In recent years, studies have shown entecavir to be superior to LAM in reducing HBV DNA, with only a 1.2% drug-resistance rate after five years.

In the current trial, James Fung, M.D., and the team led by Professor Man-Fung Yuen, M.D., Ph.D., from The University of Hong Kong, investigated whether initial HBV DNA suppression by the more potent antiviral agent, entecavir, could be maintained by switching to LAM, a less potent and lower-cost antiviral. The potential for drug-resistance and virological rebound with sequential therapy of the two antiviral therapies was also examined. "Most patients with chronic HBV require long-term and some patients opt to start with LAM therapy for cost-saving reasons. Our aim was to determine the efficacy and drug-resistance profile of switching to LAM after initial entecavir treatment," said Dr. Fung.

Researchers recruited 50 patients with chronic HBV who were all initially treated with entecavir (0.5 mg) for at least six months prior to the start of the study. A normal alanine aminotransferase (ALT) level and undetectable HBV DNA were required for inclusion in the study. Participants were randomized into two arms with patients in the first arm continuing to receive 0.5 mg of entecavir daily and patients in the second arm switching to 100 mg LAM daily. Routine liver biochemistry, serological test, and HBV DNA measurements were performed at 0, 4, 12, 24, 48, 72, and 96 weeks.

Results showed that 100% of patients in the entecavir-only arm continued to have undetectable HBV DNA, while 24% of participants who switched to LAM experienced virological rebound. Researchers noted that virological rebound continues to increase over time as two patients showed an increased in HBV DNA at 96 weeks. Additionally, three patients (12%) developed LAM-resistance. "Prior HBV DNA suppression with entecavir did not offer any significant advantage to patients who switched to LAM," concluded Dr. Fung. "The potential cost-saving benefit of switching to LAM was not realized due to the development of resistance."

Explore further: Research gives new insights into rare disease of the inner ear

More information: "Randomized Trial of Lamivudine Versus Entecavir in Entecavir-Treated Patients with Undetectable HBV DNA: Outcome At 2 Years." James Fung, Ching-Lung Lai, John Yuen, Charles Cheng, Ringo Wu, Danny Ka-Ho Wong, Wai-Kay Seto, Ivan Fan-Ngai Hung, Man-Fung Yuen. Hepatology; Published Online: February 14, 2011 ( DOI: 10.1002/hep.24192 ); Print Issue Date: April 2011.

add to favorites email to friend print save as pdf

Related Stories

Hepatitis B virus mutations may predict risk of liver cancer

Jul 02, 2009

Certain mutations in the DNA of the hepatitis B virus (HBV) are associated with the development of liver cancer and may help predict which patients with HBV infections are at increased risk of the disease, according to a ...

Why are T cells tolerant to hepatitis B virus?

Oct 14, 2008

The level of PD-1 expression has been proved by recent studies to be positively correlated with the extent of HBV-specific T cell impairments. However, the degree of T cell exhaustion which affects the disease statuses of ...

Recommended for you

Thyroid disease risk varies among blacks, Asians, and whites

14 hours ago

An analysis that included active military personnel finds that the rate of the thyroid disorder Graves disease is more common among blacks and Asian/Pacific Islanders compared with whites, according to a study in the April ...

The key to easy asthma diagnosis is in the blood

17 hours ago

Using just a single drop of blood, a team of University of Wisconsin-Madison researchers has developed a faster, cheaper and more accurate tool for diagnosing even mild cases of asthma.

Younger adults hit hardest this flu season

19 hours ago

(HealthDay)—The H1N1 flu was the predominant influenza strain in the United States this year, but it packed a lot less punch than in 2009 when it caused a worldwide pandemic, health officials report.

User comments : 0

More news stories

ESO image: A study in scarlet

This new image from ESO's La Silla Observatory in Chile reveals a cloud of hydrogen called Gum 41. In the middle of this little-known nebula, brilliant hot young stars are giving off energetic radiation that ...

First direct observations of excitons in motion achieved

A quasiparticle called an exciton—responsible for the transfer of energy within devices such as solar cells, LEDs, and semiconductor circuits—has been understood theoretically for decades. But exciton movement within ...

Warm US West, cold East: A 4,000-year pattern

Last winter's curvy jet stream pattern brought mild temperatures to western North America and harsh cold to the East. A University of Utah-led study shows that pattern became more pronounced 4,000 years ago, ...

Patent talk: Google sharpens contact lens vision

( —A report from Patent Bolt brings us one step closer to what Google may have in mind in developing smart contact lenses. According to the discussion Google is interested in the concept of contact ...