Simple Scoring System Predicting Genotypic Resistance During Rescue Therapy for Lamivudine-Resistant Chronic Hepatitis B.

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J Clin Gastroenterol. 2011 Jun 28. [Epub ahead of print]

Simple Scoring System Predicting Genotypic Resistance During Rescue Therapy for

Lamivudine-Resistant Chronic Hepatitis B.

Lee JH, Yoon JH, Cho EJ, Yang HJ, Jang ES, Kwak MS, Hwang SY, Yu SJ, Lee CH, Kim

YJ, Kim CY, Lee HS.

Source

*Department of Internal Medicine and Liver Research Institute ¢ÓDepartment of

Internal Medicine, Seoul Metropolitan Boramae Medical Center, Seoul National

University College of Medicine, Seoul, Republic of Korea.

Abstract

GOAL:

In this study, we aimed to devise a simple scoring system predicting the risk of

genotypic resistance (GR) to current rescue therapies for patients with

lamivudine (LAM)-resistant chronic hepatitis B.

BACKGROUND:

LAM and adefovir (ADV) combination therapy should be recommended for an initial

rescue therapy against LAM-resistant hepatitis B virus (HBV). However, there

still are many LAM-resistant patients being treated with entecavir (ETV) or ADV

monotherapy.

STUDY:

This retrospective cohort study included consecutive patients treated for

LAM-resistant chronic hepatitis B with ETV or ADV monotherapy, or LAM/ADV

combination therapy. The cumulative probabilities of GR and virological

responses and breakthrough according to clinical variables were analyzed by

survival analyses and derived an index for future GR.

RESULTS:

A total of 224 patients were included (median treatment duration=117.9 wk).

Using risk factors indentified on multivariable analyses, a simple index for

future GR (Antiviral Resistance Prediction Index, ARPI) was developed with 3

clinical variables: the rescue therapy regimens (+0, ADV; +1, ETV; +2, LAM/ADV),

HBV DNA reduction at 12 weeks (+0, <3 log10 copies/mL; +1, >3 log10 copies/mL),

and the initial HBV DNA level (+0, >10 copies/mL; +1, <10 copies/mL). No patient

with ARPI ¡Ã2 exhibited GR, whereas 47% of the patients with an ARPI <2

developed GR by week 144 (P=0.005).

CONCLUSIONS:

The results of this study suggest that the ARPI is a simple and early index that

can be used to determine the risk for subsequent GR during rescue therapy for

LAM-resistant chronic hepatitis B.

PMID: 21716122 [PubMed - as supplied by publisher]