Adefovir dipivoxil is less expensive than lamivudine and associated with similar prognosis in patients with hepatitis B virus-related hepatocellular carcinoma after radical resection

Abstract

Aim: Lamivudine (LAM) and adefovir dipivoxil (ADV) are widely used in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), but few studies have directly compared their therapeutic efficacy and treatment cost. This study aims to compare LAM with ADV head-to-head in these patients.

Methods: We retrospectively analyzed 201 patients with HBV-related HCC who underwent radical resection and subsequently received LAM (n=155) or ADV (n=46). The two groups were compared in terms of HBV-DNA levels, liver function, antiviral resistance, recurrence-free, and overall survival, as well as antiviral medication costs.

Results: Despite significant improvement in HBV-DNA and alanine aminotransferase level in the LAM group after 1 year of antiviral therapy, these parameters did not differ significantly between the two groups over the following 2 years. Incidence of antiviral resistance after 1, 2, and 3 years of antiviral treatment was significantly higher in the LAM group (19.5%, 45.7%, and 56.4%) than in the ADV group (0%, 3.3%, and 14.5%; P<0.001). Overall survival at 1, 2, and 3 years after resection was similar for the LAM group (84.5%, 69.3%, and 64.6%) and the ADV group (84.1%, 77.8%, and 63.4%; P=0.905). Recurrence-free survival at the three follow-up points was also similar for the LAM group (71.7%, 58.3%, and 43.9%) and the ADV group (81.1%, 66.1%, and 53.0%; P=0.452). Cox regression analysis confirmed that both nucleos(t)ide analogues were associated with similar overall and recurrence-free survival. However, the average medication costs after 1, 2, and 3 years of antiviral treatment were significantly higher in the LAM group (€3.0, €4.8, and €5.6 per person per day) than in the ADV group (€2.2, €2.4, and €3.1 per person per day; all P<0.05).

Conclusion: ADV and LAM are associated with similar survival benefit in patients with HBV-related HCC after radical resection, but ADV is more cost-effective.

Keywords: adefovir dipivoxil; hepatitis B virus; hepatocellular carcinoma; lamivudine; radical resection.

Figure 1

Flow diagram of study population selection. Abbreviations: ADV, adefovir dipivoxil; HBsAg, hepatitis B surface antigen; HCC, hepatocellular carcinoma; HIV, human immunodeficiency virus; LAM, lamivudine; PEI, percutaneous ethanol injection; RFA, radiofrequency ablation; TACE, transarterial chemoembolization.

Figure 2

Comparison of cumulative antiviral resistance during LAM or ADV treatment in propensity score-matched patients with HBV-related HCC after radical resection. Abbreviations: ADV, adefovir dipivoxil; LAM, lamivudine; HCC, hepatocellular carcinoma; HBV, hepatitis B virus.

Figure 3

Average anti-HBV medication costs in LAM and ADV groups at the end of 0, 1, 2, and 3 years of antiviral therapy. Notes: Data were reported as per-patient-per-day due to variable follow-up periods. *P<0.05, LAM versus ADV groups. Abbreviations: ADV, adefovir dipivoxil; LAM, lamivudine; HBV, hepatitis B virus.

Figure 4

Survival curves of patients in the LAM and ADV groups. Notes: (A) Overall survival and (B) recurrence-free survival between the LAM and ADV groups before propensity score matching. (C) Overall survival and (D) recurrence-free survival between the LAM and ADV groups after propensity score matching. Abbreviations: ADV, adefovir dipivoxil; LAM, lamivudine.