WARNING: SEVERE ACUTE EXACERBATIONS OF HEPATITIS, NEPHROTOXICITY, HIV RESISTANCE, LACTIC ACIDOSIS AND SEVERE HEPATOMEGALY WITH STEATOSIS
Severe acute exacerbations of hepatitis have been reported in patients who have discontinued anti-Hepatitis B therapy including HEPSERA. Hepatic function should be monitored closely with both clinical and laboratory follow-up for at least several months in patients who discontinue anti-Hepatitis B therapy. If appropriate, resumption of anti-Hepatitis B therapy may be warranted [see Warnings and Precautions].
In patients at risk of or having underlying renal dysfunction, chronic administration of HEPSERA may result in nephrotoxicity. These patients should be monitored closely for renal function and may require dose adjustment [see Warnings and Precautions and Dosage and Administration].
HIV resistance may emerge in chronic hepatitis B patients with unrecognized or untreated Human Immunodeficiency Virus (HIV) infection treated with anti-hepatitis B therapies, such as therapy with HEPSERA, that may have activity against HIV [see Warnings and Precautions].
Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogs alone or in combination with other antiretrovirals [see Warnings and Precautions].
HEPSERA┬« is the tradename for adefovir dipivoxil, a diester prodrug of adefovir. Adefovir is an acyclic nucleotide analog with activity against human hepatitis B virus (HBV).
HEPSERA is indicated for the treatment of chronic hepatitis B in patients 12 years of age and older with evidence of active viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease.
This indication is based on histological, virological, biochemical, and serological responses in adult patients with HBeAg+ and HBeAg- chronic hepatitis B with compensated liver function, and with clinical evidence of lamivudine-resistant hepatitis B virus with either compensated or decompensated liver function.
For patients 12 to <18 years of age, the indication is based on virological and biochemical responses in patients with HBeAg+ chronic hepatitis B virus infection with compensated liver function.
Published Studies Related to Hepsera (Adefovir Dipivoxil)
Hepatitis B virus wild-type and rtN236T populations show similar early HBV DNA
decline in adefovir refractory patients on a tenofovir-based regimen. 
Hepatitis B virus (HBV) pol/RT mutations that confer clinical resistance to
tenofovir disoproxil fumarate (TDF) have not been detected to date. In vitro, the
rtN236T adefovir dipivoxil (ADV)-associated resistance mutation confers low-level
cross-resistance to tenofovir: 3- to 13-fold changes in EC(50) from wild type...
[One-year combination therapy de novo of adefovir dipivoxil and lamivudine for decompensated cirrhosis related to HBV]. [2011.04]
OBJECTIVE: To evaluate the efficacy and potential renal impairment of one-year combination therapy de novo of adefovir dipivoxil (ADV) and lamivudine (LMV) for decompensated cirrhosis related to HBV... CONCLUSION: Present study reveals that in populations with decompensated cirrhosis related to HBV, one-year combination therapy de novo of ADV and LMV is superior to monotherapy of LMV, and the renal safety is favorable within one year.
Peginterferon plus adefovir versus either drug alone for hepatitis delta. [2011.01.27]
BACKGROUND: Chronic infection with hepatitis B virus and hepatitis delta virus (HDV) results in the most severe form of viral hepatitis. There is no currently approved treatment. We investigated the safety and efficacy of 48 weeks of treatment with peginterferon alfa-2a plus adefovir dipivoxil, peginterferon alfa-2a alone, and adefovir dipivoxil alone... CONCLUSIONS: Treatment with peginterferon alfa-2a for 48 weeks, with or without adefovir, resulted in sustained HDV RNA clearance in about one quarter of patients with HDV infection. (Current Controlled Trials number, ISRCTN83587695.).
Adefovir plus lamivudine are more effective than adefovir alone in lamivudine-resistant HBeAg- chronic hepatitis B patients: a 4-year study. [2010.01]
BACKGROUND AND AIM: Adefovir dipivoxil (ADV) is effective in lamivudine (LAM)-resistant hepatitis B e antigen-negative (HBeAg(-)) chronic hepatitis B (CHB). However, it is unclear whether LAM treatment should be continued in these patients. We aimed to compare the long-term efficacy of adding ADV to ongoing LAM treatment versus switching to ADV monotherapy in LAM-resistant HBeAg(-) CHB... CONCLUSIONS: Adding ADV to LAM is more effective than switching to ADV monotherapy in LAM-resistant patients with HBeAg(-) CHB.
[Efficacy and durability of generic adefovir dipivoxil in patients with HBeAg positive chronic hepatitis] [2009.12]
OBJECTIVE: To study the efficacy and durability of generic adefovir dipivoxil (ADV) in patients with HBeAg positive chronic hepatitis... CONCLUSIONS: Treatment of chronic hepatitis B with generic ADV was effective and well tolerated, but relapse may develop when treatment was discontinued.
Clinical Trials Related to Hepsera (Adefovir Dipivoxil)
HEPSERA Post Marketing Surveillance [Completed]
Lamivudine and Adefovir Dipivoxil Fixed Dose Combination [Completed]
This is a phase I study being conducted to support the clinical development program of a FDC
product of the nucleoside analogue lamivudine and the nucleotide analogue adefovir
dipivoxil. To establish bioequivalence, the exposure of lamivudine and adefovir dipivoxil
when administered as the FDC will be compared to that of Heptodin (lamivudine) and Hepsera
(adefovir dipivoxil) when administered separately. In this study, the FDC product will
contain 100mg lamivudine/10mg adefovir dipivoxil.
Total 40 healthy adult subjects will be enrolled. The study will include a screening visit
and two treatment sessions. The screening visit will be conducted up to 3 weeks prior to
the first dose of Session 1. All subjects will receive Regimen A through B according to the
randomization schedule. Eligible subjects will be enrolled in the study and randomized to
receive the following treatment regimens in table below in one of the following treatment
sequences: AB, or BA. There will be a seven to ten days washout period between each
treatment session. Pharmacokinetic sampling for measurement of plasma lamivudine and
adefovir dipivoxil concentrations will be conducted over a 48-hour period following the
morning administration of study medication in each study session. During this time, all
subjects will remain in the unit for pharmacokinetic (PK) sample collection. The total
duration (from screening to the end of the study) of each subject's participation will be
approximately four weeks.
Comparison of Telbivudine Plus Adefovir With Lamivudine Plus Adefovir for the Treatment of Lamivudine-resistant Chronic Hepatitis B at 52 Weeks: A Pilot Study [Recruiting]
Lamivudine had been widely used for treatment-na´ve chronic hepatitis B patients. However,
development of antiviral resistance has been known as the major drawback: Incidence of
lamivudine resistance was reported to be approximately 70% after 5 years (Lok AS et al,
2003). For the treatment of lamivudine resistance, adefovir has been widely used (Lok AS and
McMahon B, 2009). However, switching to adefovir monotherapy was also reported to be at high
risk of resistance, 25% at year 2 (Yeon JE et al, 2006). Recently, adding adefovir on
lamivudine was shown to be superior to switching to adefovir monotherapy by decreasing the
adefovir resistance (Rapti I et al, 2007, Lampertico P et al, 2007). However, combination of
adefovir and lamivudine does not increase antiviral activity compared with adefovir
monotherapy in patients with lamivudine resistance (Peters MG et al, 2004). As many patients
are still viremic with the treatment of lamivudine and adefovir over 1 year, the
investigators need more potent combination of the drugs. Telbivudine is a new nucleoside
analogue with potent antiviral activity. The previous phase III study has shown the
superiority of telbivudine over lamivudine in HBeAg positive and negative subjects (Lai CL
et al, 2007). Therefore, telbivudine plus adefovir may be a better treatment option than
lamivudine plus adefovir for the lamivudine-resistant chronic hepatitis B patients. No study
assessing the efficacy of telbivudine plus adefovir has been conducted for these patients.
The aim of this study is to evaluate the safety and efficacy of telbivudine plus adefovir
compared with lamivudine plus adefovir in lamivudine resistant chronic hepatitis B patients
at the end of 1 year follow-up,
Entecavir Plus Adefovir in Lamivudine-Resistant Chronic Hepatitis B Patients Who Fail Lamivudine Plus Adefovir [Completed]
The presence of persistent inadequate or suboptimal virologic response is a strong risk
factor for viral resistance and breakthrough and also for disease progression of chronic
hepatitis B, and thus, a change in therapy is required. The combination of entecavir (ETV)
and adefovir (ADV) is a promising treatment for patients with lamivudine (LAM)-resistance
who show suboptimal response to the combination of LAM and ADV.
In this randomized, open labeled trial,the investigators will compare the efficacy of
continuation of ADV plus LAM versus switch to ADV plus ETV in adults with LAM-resistant
chronic hepatitis B who shows suboptimal response to the combination treatment of ADV and
Switch to Tenofovir Versus Continue Lamivudine/Adefovir Treatment in Lamivudine-resistance Chronic Hepatitis B Patients [Recruiting]
1. Adefovir add-on therapy is superior to switching to adefovir monotherapy or entecavir
1mg monotherapy for chronic hepatitis B (CHB) patients with lamivudine resistance
2. Long-term adefovir add-on therapy was effective for viral suppression. However, the
economic burden for such dual antiviral therapy is heavy because of infinite treatment.
3. Tenofovir disoproxil fumarate (TDF) is a potent antiviral agent. TDF demonstrated
potent antiviral efficacy in a subset of lamivudine experienced HBeAg-positive
patients. TDF is also superior to ADV in HBeAg-negative and HBeAg-positive
4. Theoretically, TDF can replace LAM/ADV when viral suppression has been achieved by
LAM/ADV combination treatment in LAM-R CHB patients.
Reports of Suspected Hepsera (Adefovir Dipivoxil) Side Effects
Blood Creatinine Increased (34),
Renal Impairment (33),
Fanconi Syndrome (30),
Blood Alkaline Phosphatase Increased (26),
Multiple Fractures (25),
Blood Phosphorus Decreased (22),
Fanconi Syndrome Acquired (18),
Arthralgia (18), more >>
Page last updated: 2014-11-30