Two-year Efficacy of the Real World Roadmap Concept for Lamivudine Therapy in Chronic Hepatitis B Patients at Songklanagarind Hospital
Pimsiri Sripongpun MD1, Nopporn Charoenthong MD1 Naichaya Chamroonkul MD1, Chanon Kongkamol MD2, Teerha Piratvisuth MD1
Affiliation : 1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand 2 Research unit of Holistic Health and Safety Management in Community, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Objective : The roadmap concept of adding-on non-cross resistance antiviral therapy for chronic hepatitis B patients who do
not achieve an early virological response at week 24 after treatment was introduced in 2007; aiming to improve long-term viral
suppression rate. However, the clinical data to prove this concept are still scarce. This study is to evaluate 2-year efficacy
of this approach applied to the real world practice of lamivudine therapy.
Materials and Methods : The data of adult chronic hepatitis B patients in Songklanagarind Hospital from 2004 to 2011 were
retrospective analyzed. Inclusion criteria were patients on lamivudine monotherapy at baseline and having regular follow-up
for >2 years. Exclusion criteria were patients with coinfection with hepatitis C and/or human immunodeficiency virus,
coexisting malignancy, co-prescription with immunosuppressant(s), and pregnancy. Patients who received treatment
modification at week 24 were classified as the roadmap group [RG] and the remaining patients were the conventional group
[CG]. Treatment outcomes were measured at week 96 in terms of virological response, virological breakthrough, and
biochemical response rates.
Results : Of the 3,551 chronic hepatitis B patients during the study period, a total of 253 patients were eligible for the study.
Seventy-seven patients (30.4%) were classified as the RG and 176 patients were in the CG. At week 96, patients in the RG
achieved a significantly higher rate of undetectable virus compared with the CG (83% vs. 63%, p = 0.002), and less virological
breakthrough (17% vs. 32%, p = 0.017). Biochemical response was also high (92% vs.78%, p = 0.066).
Conclusion : Lamivudine therapy with the application of the roadmap concept is an effective approach for chronic hepatitis
B treatment in real world practice.
Keywords : Efficacy, Hepatitis B, Lamivudine, Roadmap, Treatment
