Article: The duration of lamivudine therapy for chronic hepatitis b: Cessation vs. continuation of treatment after HBeAg seroconversion

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TitleThe duration of lamivudine therapy for chronic hepatitis b: Cessation vs. continuation of treatment after HBeAg seroconversion
AuthorsFung, J2
Lai, CL2
Tanaka, Y1
Mizokami, M2
Yuen, J2
Wong, DKH2
Yuen, MF2
Issue Date2009
PublisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/ajg/index.html
CitationAmerican Journal Of Gastroenterology, 2009, v. 104 n. 8, p. 1940-1946 [How to Cite?]
DOI: http://dx.doi.org/10.1038/ajg.2009.200
AbstractOBJECTIVES: The aim of this study was to compare the virological and biochemical relapse rates in Asian chronic hepatitis B patients with lamivudine-induced hepatitis B e antigen (HBeAg) seroconversion, between those who stopped therapy after HBeAg seroconversion and those who continued to receive lamivudine.METHODS:All patients with lamivudine-induced HBeAg seroconversion were included. Patients who stopped lamivudine after HBeAg seroconversion (n22) were compared with 79 patients who continued to receive lamivudine (n79). Demographic, virological, and biochemical parameters were recorded at baseline, and throughout the duration of follow-up.RESULTS:In patients who stopped lamivudine, the median follow-up after stopping lamivudine was 20 months. Of these patients, 14 (64%) had virological rebound, with a cumulative incidence of 82% at 4 years. There was no significant difference in number of flares between patients with normal alanine aminotransferase (ALT) and undetectable hepatitis B virus (HBV) DNA at the time of stopping lamivudine compared with that in patients with either abnormal ALT, detectable HBV DNA, or both (P0.73). The cumulative incidence of HBeAg seroreversion and ALT flares at 5 years after stopping lamivudine was 9 and 44%, respectively. Of the 79 patients who continued with lamivudine, 62 (78%) had undetectable HBV DNA at the time of last follow-up, whereas no patients had undetectable HBV DNA after stopping lamivudine (P<0.001). The cumulative incidence of ALT flares at 5 years was 16% (P<0.001 compared with those who stopped taking lamivudine). After a median treatment duration of 79 months, lamivudine-resistant mutations occurred in eight patients (10%).CONCLUSIONS:In Asian HBeAg-positive patients, continuing with lamivudine after achieving HBeAg seroconversion was associated with a higher proportion of undetectable HBV DNA and a lower number of ALT flares, when compared with those with cessation of lamivudine. In patients who achieved HBeAg seroconversion with lamivudine, the resistance rate was not high when treatment was continued after HBeAg seroconversion. © 2009 by the American College of Gastroenterology.
ISSN0002-9270
2011 Impact Factor: 7.282
2011 SCImago Journal Rankings: 0.573
DOIhttp://dx.doi.org/10.1038/ajg.2009.200
ISI Accession Number IDWOS:000268965300008
ReferencesReferences in Scopus
DC Field
Value
dc.contributor.authorFung, J
dc.contributor.authorLai, CL
dc.contributor.authorTanaka, Y
dc.contributor.authorMizokami, M
dc.contributor.authorYuen, J
dc.contributor.authorWong, DKH
dc.contributor.authorYuen, MF
dc.date.accessioned2012-09-05T05:29:17Z
dc.date.available2012-09-05T05:29:17Z
dc.date.issued2009
dc.description.abstractOBJECTIVES: The aim of this study was to compare the virological and biochemical relapse rates in Asian chronic hepatitis B patients with lamivudine-induced hepatitis B e antigen (HBeAg) seroconversion, between those who stopped therapy after HBeAg seroconversion and those who continued to receive lamivudine.METHODS:All patients with lamivudine-induced HBeAg seroconversion were included. Patients who stopped lamivudine after HBeAg seroconversion (n22) were compared with 79 patients who continued to receive lamivudine (n79). Demographic, virological, and biochemical parameters were recorded at baseline, and throughout the duration of follow-up.RESULTS:In patients who stopped lamivudine, the median follow-up after stopping lamivudine was 20 months. Of these patients, 14 (64%) had virological rebound, with a cumulative incidence of 82% at 4 years. There was no significant difference in number of flares between patients with normal alanine aminotransferase (ALT) and undetectable hepatitis B virus (HBV) DNA at the time of stopping lamivudine compared with that in patients with either abnormal ALT, detectable HBV DNA, or both (P0.73). The cumulative incidence of HBeAg seroreversion and ALT flares at 5 years after stopping lamivudine was 9 and 44%, respectively. Of the 79 patients who continued with lamivudine, 62 (78%) had undetectable HBV DNA at the time of last follow-up, whereas no patients had undetectable HBV DNA after stopping lamivudine (P<0.001). The cumulative incidence of ALT flares at 5 years was 16% (P<0.001 compared with those who stopped taking lamivudine). After a median treatment duration of 79 months, lamivudine-resistant mutations occurred in eight patients (10%).CONCLUSIONS:In Asian HBeAg-positive patients, continuing with lamivudine after achieving HBeAg seroconversion was associated with a higher proportion of undetectable HBV DNA and a lower number of ALT flares, when compared with those with cessation of lamivudine. In patients who achieved HBeAg seroconversion with lamivudine, the resistance rate was not high when treatment was continued after HBeAg seroconversion. © 2009 by the American College of Gastroenterology.
dc.description.natureLink_to_subscribed_fulltext
dc.identifier.citationAmerican Journal Of Gastroenterology, 2009, v. 104 n. 8, p. 1940-1946 [How to Cite?]
DOI: http://dx.doi.org/10.1038/ajg.2009.200
dc.identifier.doihttp://dx.doi.org/10.1038/ajg.2009.200
dc.identifier.epage1946
dc.identifier.hkuros158445
dc.identifier.isiWOS:000268965300008
dc.identifier.issn0002-9270
2011 Impact Factor: 7.282
2011 SCImago Journal Rankings: 0.573
dc.identifier.issue8
dc.identifier.pmid19455108
dc.identifier.scopuseid_2-s2.0-68349128691
dc.identifier.spage1940
dc.identifier.urihttp://hdl.handle.net/10722/163262
dc.identifier.volume104
dc.languageeng
dc.publisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/ajg/index.html
dc.publisher.placeUnited States
dc.relation.ispartofAmerican Journal of Gastroenterology
dc.relation.referencesReferences in Scopus
dc.subject.meshAdult
dc.subject.meshChina
dc.subject.meshFemale
dc.subject.meshHepatitis B E Antigens - Blood
dc.subject.meshHepatitis B, Chronic - Blood - Drug Therapy - Immunology
dc.subject.meshHumans
dc.subject.meshLamivudine - Administration & Dosage
dc.subject.meshMale
dc.subject.meshMiddle Aged
dc.subject.meshReverse Transcriptase Inhibitors - Administration & Dosage
dc.subject.meshTime Factors
dc.subject.meshYoung Adult
dc.titleThe duration of lamivudine therapy for chronic hepatitis b: Cessation vs. continuation of treatment after HBeAg seroconversion
dc.typeArticle
Author Affiliations
  1. Nagoya City University
  2. The University of Hong Kong