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FDA Alert: HEPSERA, use adefovir with lamivudine to prevent drug resistance
  On May 27 2008, the US Food and Drug Administration (FDA) has approved safety labeling revisions to advise of therapeutic recommendations that may reduce the risk for resistance to adefovir dipivoxil therapy.
Recommendations for Adefovir Dipivoxil (Hepsera) Usage May Reduce Risk for Resistance
On May 27, the FDA approved safety labeling revisions for adefovir dipivoxil (Hepsera; Gilead Sciences, Inc) to advise of the potential for clinical resistance.
Resistance to adefovir can result in viral load rebound and exacerbation of hepatitis B virus infection (HBV), potentially leading to liver decompensation and fatal outcome in patients with diminished hepatic function.
To decrease the risk for resistance in patients with lamivudine-resistant HBV, adefovir should be administered in combination with lamivudine rather than as monotherapy. For those receiving adefovir alone, treatment modifications should be considered if serum HBV DNA levels remain above 1000 copies/mL with continued therapy.
The latter recommendation is based on long-term (144-week) data from an adefovir clinical trial (n = 124), in which HBV DNA levels greater than 1000 copies/mL at week 48 were associated with an increased risk for the development of resistance.
Adefovir is indicated for the treatment of HBV in patients aged 12 years and older who have evidence of active viral replication and either persistent elevations in serum aminotransferases or histologically active disease.
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