M1920 The Efficacy of Combination Therapy with Adefovir and Lamivudine in Patients with Chronic Hepatitis B

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Chronic hepatitis B (CHB) may lead to cirrhosis and hepatocellular carcinoma. Treatment with monotherapy, using either a nucleoside or nucleotide analogues, has been recommended, though phenotypic and genotypic resistance is not uncommon while on treatment. Combination with a nucleoside and a nucleotide analogue can lead to a more rapid viral suppression, and prevention of resistance to treatment. Aim: To investigate the swiftness of combination treatment in the viral load decline and seroconversion using adefovir 10 mg and lamivudine 100 300 mg daily. Methods: This is a retrospective chart review study of patients with chronic hepatitis B undergoing combination treatment. A total of 25 patients (15 men and 10 women) median age of 45 years old, were studied. Twenty patients were naive, five patients underwent treatment in the past, zero developed resistance and four were non-adherent. Eighty percent of the patients were found to be e antigen negative. Liver biopsy was performed on 76% of patients, and 20% were identified with cirrhosis. At initiation of therapy, 10 of 25 patients had elevated AST (median 71) and 11 of 25 had elevated ALT (median 58). The median viral load at initiation was 23,100 IU/ml (viral load was measured by HBV QuantaSure, LabCorp). The viral load was checked between every 3 weeks to 3 months. No virologic breakthrough was noted for those patients who remained on treatment. Fifteen of eighteen patients had either precore or BCP mutations (13 e Antigen negative, 2 e Antigen positive). Genotyping was done for 74% of the patients. The distribution was: 41 % type A, 35% type B, 18 % type C, and 6 % type D. Results: By week 21, all 25 patients had achieved an undetectable viral load (<100 IU/mL) and continued undetectable if they stayed on medication. Four patients stopped treatment and experienced a rise in the viral load. The mean time on therapy was 82 weeks (range 34 to 198 weeks). No virologic breakthrough occurred in patients who continued treatment. For the e antigen population, complete e antigen seroconversion was achieved in 67% of the patients at a median time of 54 weeks. The liver enzymes were normalized in 24 of 25 patients. Two of the patients underwent orthotopic liver transplantation shortly after initiation of treatment, and though the viral load was detectable at the time of the procedure, it became undetectable shortly after. Conclusion: Effective and rapid viral suppression may be achieved by using the combination of a nucleotide agent with a nucleoside analogue. Combination therapy may avoid the development of resistance. Sustainability is something that has to be further evaluated.