Stopping lamivudine therapy after biochemical breakthrough may be a feasible opt

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J Med Virol. 2005 Nov;77(3):367-73.

Stopping lamivudine therapy after biochemical breakthrough may be a feasible

option in selected HBeAg-positive patients.

Jang JW, Choi JY, Bae SH, Yoon SK, Kim CW, Nam SW, Lee CD, Lee YS, Cha SB,

Chung KW.

Department of Internal Medicine, College of Medicine, WHO collaborating

Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea.

Drug resistance remains a major problem during lamivudine treatment for

patients with hepatitis B virus infection. Continuing or stopping lamivudine

in patients with biochemical breakthrough is an issue that has not been

investigated extensively. Particularly, HBeAg seroconversion and its

durability achieved in these settings have never been studied so far. In

this study, we compared the clinical outcomes including HBeAg seroconversion

in hepatitis B e antigen (HBeAg)-positive patients who either continued or

stopped lamivudine treatment after biochemical breakthrough. This was a

retrospective cohort study of 73 consecutive patients with biochemical

breakthrough followed up for at least 12 months. Of these, 35 (Group I)

stopped and the remaining 38 (Group II) continued lamivudine therapy after

breakthrough. During 12 months, there was a tendency towards higher rates of

HBeAg seroconversion in Group I compared with Group II (P = 0.078). By

multivariate analysis, age >or=45 years and acute exacerbation within 6

months of stopping lamivudine were the two independent predictors of HBeAg

seroconversion for Group I (P = 0.034 and P = 0.012, respectively). There

was no difference in the overall incidence of acute exacerbation and hepatic

decompensation between the two groups (P = 0.333 and P = 0.555,

respectively). Six patients (17.1%) in Group I developed hepatic

decompensation, for which bilirubin >or=1.2 mg/dl was an independent

predictor (P = 0.002). The therapeutic gain in continuing lamivudine for

biochemical breakthrough is questionable. This study suggests that

discontinuation of lamivudine may be an option in older patients with normal

bilirubin level. © 2005 Wiley-Liss, inc.

Publication Types:

Clinical Trial

PMID: 16173025 [PubMed - indexed for MEDLINE]

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