Korean J Hepatol.  2006 Jun;12(2):184-190.

Comparison of Clinical Outcome Between Patients Continuing and Discontinuing Lamivudine Therapy in Acute Exacerbation After Viral breakthrough During Lamivudine Therapy in Chronic Hepatitis B

• Eun JR

Abstract

BACKGROUNDS/AIMS: Continuation of lamivudine therapy is controversial for patients with chronic hepatitis B when viral breakthrough occurs. Moreover, the effect of continuous lamivudine therapy is unknown in patients with acute exacerbation after viral breakthrough. We assessed clinical course of acute exacerbation after viral breakthrough in patients who continued and discontinued lamivudine therapy. METHODS: Medical records of 109 patients with viral breakthrough during lamivudine therapy were reviewed. Of 40 patients with acute exacerbation (ALT level > 5 x ULN), adefovir dipivoxil was unavailable in 38 patients. These 38 patients (mean age 42.6 years; male/female, 34/6) were divided into continuation (n=21) and discontinuation (n=17) groups. Clinical courses of the 2 groups were compared. RESULTS: During follow-up period (mean, 27 months; range, 6-60 months), ALT levels decreased to < 2 x ULN in 11 patients (52%) of continuation group and 9 patients (53%) of discontinuation group, varied from 2 x to 5 x ULN in 9 (43%) and 5 (29%), respectively, and increased to > 5 x ULN in 1 (5%) and 3 (18%), respectively, with no statistical significance (P=.417). CONCLUSIONS: When acute exacerbation of ALT levels occurs after viral breakthrough during lamivudine administration in patients with compensated chronic hepatitis B, continuation of lamivudine may have no advantage over discontinuation.

Keyword

Hepatitis B, chronic; Drug resistance, viral; Lamivudine; Outcome assessment; Viral breakthrough

MeSH Terms

Phosphonic Acids/therapeutic use
Middle Aged
Male
Lamivudine/*administration & dosage
Humans
Hepatitis B, Chronic/drug therapy/enzymology/*virology
Hepatitis B virus/*isolation & purification
Female
Antiviral Agents/*administration & dosage
Alanine Transaminase/blood
Aged
Adult
Adenine/analogs & derivatives/therapeutic use
Acute Disease