Observation of combined-optimized therapy of Lamivudine and Adefovir Dipivoxyl for hepatitis B-induced decompensated cirrhosis with baseline HBV DNA>1,000 IU-mL

Objective : This study aimed to observe and compare the efficacy and safety of the combined therapy and two different optimized therapies of lamivudine (LAM) and adefovir dipivoxil (ADV), as well as entecavir (ETV) monotherapy in patients with hepatitis B-induced decompensated cirrhosis. Method : A total of 127 patients with decompensated cirrhosis were divided into four groups, and each group received different doses of regimens: initial combination of LAM and ADV, ADV add- on therapies with previous 12-week LAM, ADV add-on therapies with previous 24-week LAM, and ETV monotherapy. Results : At the end of the treatment, the level of alanine amino- transferase (ALT), albumin (ALB) and total bilirubin (TBIL) in the combination therapy group and 12-week optimized therapy group were significantly improved. For the 24-week optimized therapy group, only ALT levels revealed a significant improvement. There were no obvious differences in the normalization rate of ALT, negative conversion rate of HBV DNA and HBeAg, as well as improvement in Child-Pugh scores among the combination therapy group, 12-week optimized therapy group, and ETV monotherapy group. However, the difference among these three groups and the 24-week optimized therapy group were significant. Differences were not observed in the HBeAg seroconversion between each group. Differences in blood urea nitrogen, serum creatinine, creatine kinase, or other serious adverse effects were not observed in each group at the end of the 96-week treatment. Conclusion : Combination therapy and early ADV addition were the preferred approaches in the antiviral strategy for the treatment of hepatitis B-induced decompensated cirrhosis. (Acta gastroenterol. belg., 2017, 80, 9-13).