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Prior to the use of more-potent antiviral agents, such as entecavir (ETV) and tenofovir, lamivudine (LAM) was the antiviral agent of choice. Although significantly cheaper than the current agents, LAM is associated with high rates of resistance and not considered first-line therapy for chronic hepatitis B virus (HBV) infection. One potential cost-reduction approach is to initially control HBV infection with a first-line agent and then, once the virus is undetectable, switch to LAM for long-term maintenance.
To evaluate this approach, researchers in Hong Kong randomized 50 patients with virologically undetectable HBV DNA and normalized liver enzymes either to continue ETV (0.5 mg/day) or to switch to LAM (100 mg/day). All patients were initia…