Comparison of efficacy of three treatment strategies in lamivudine-refractory patients with chronic hepatitis B:Adefovir dipivoxil mono-therapy,entecavir mono-therapy and lamivudine plus adefovir dipivoxil

Objective To evaluate the efficacy of adefovir dipivoxil monotherapy,entecavir monotherapy and lamivudine plus adefovir dipivoxil in lamivudine-refractory patients with chronic hepatitis B.Methods Chinese and English articles published in PUBMED,EMBASE,CNKI before July 2010 about comparison of efficacy adefovir dipivoxil monotherapy,entecavir monotherapy and lamivudine plus adefovir dipivoxil in lamivudine-refractory patients with chronic hepatitis B were searched.The dosage of lamivudine,adefovir dipivoxil and entecavir were 100 mg/d,10mg/d and 1mg/d respectively,with continuing time all last over 48 weeks.Heterogeneity was examined by Chi-square test,the relative risk was calculated and forest-plot was drawn.The evaluated index was the rate of undetected serum HBV DNA.Results The rate of undetected serum HBV DNA in 48 weeks in the group of adefovir dipivoxil monotherapy was lower than that in the group of entecavir monotherapy(Z=2.26,P=0.02),and the confidence interval of relative risk was 0.51~0.95,however,there was no significant differece in the rates of undetected serum HBV DNA(P=0.25) in 48 weeks between the group of lamivudine plus adefovir dipivoxil and the group of entecavir mono-therapy.Conclusion Entecavir monotherapy is superior to adefovir dipivoxil monotherapy in decreasing serum HBV DNA in lamivudine-refractory patients with chronic hepatitis B,but the efficacy between lamivudine plus adefovir dipivoxil and entecavir monotherapy for lamivudine-refractory patients with chronic hepatitis B is similar.