Analysis The Efficacy Of Switching Lamivudine Combined With Adefovir Dipivoxil De Novo To Entecavir Monotherapy In Treatment For Patients With Chronic Hepatitis B And Compensated Liver Cirrhosis

ObjectiveTo analysis the efficacy of Lamivudine(LAM) combined with Adefovir Dipivoxil (ADV) de novo switching to Entecavir(ETV) monotherapy in treatment for patients with chronic hepatitis B (CHB) and compensated liver cirrhosis for 3 years.MethodsWe enrolled 290 CHB and compensated liver cirrhosis patients treated with LAM combined with ADV de novo for more than 1 year, and then switching to ETV monotherapy for 3 years. We tested liver and kidney function, estimated glomerular filtration rate (eGFR), HBVDNA for every 3 months. We also detected urine β2-Microglobulin (β2-M) and Rentinol binding protein (RBP) for every 6 months.ResultsAfter switching to ETV monotherapy, the HBV DNA negative rate were 77.6%, 84.5% and 94.5% at year 1,2 and 3 respectively, and were 69.3%,73.4%,80.3% in control LAM+ADV combination group. The HBV DNA negative rate were significant higher in switching group than that in combination group at year 2 and 3, P values were 0.047 and 0.038 respectively. The cumulative genetic mutation rate was 1.4% in switching group and 8.6% in control combination group respectively (P=0.014). The serum creatinine level and eGFR remained stable in the switching group. Only 0,0.3%, 1.0% of patients decreased in eGFR more than 30% from baseline and 0,0 and 0.7%of patients increased in creatinine more than 50μmol/L from baseline at yearl,2 and 3 respectively in switching group. While there were 6.2%,12.1% and 22.1% of patients decreased in eGFR more than 30% from baseline and 1.7%,4.5% and 6.6% of patients increased in creatinine more than 50μmol/L from baseline at yearl,2 and 3 respectively in control combination group. The urine β2-M and RBP abnormal rate in switching group was also lower than that in control combination group.ConclusionLAM combined with ADV de novo therapy should be switched to ETV monotherapy as soon as possible for CHB and compensated liver cirrhosis patients. Because the switching therapy can increase the HBV DNA negative rate, reduce the genetic mutation rate and also can prevent renal damage caused by LAM and ADV combination therapy.