Thai Journal of Gastroenterology

Article :
Prevalence of Flares after Stopping Lamivudine in Lamivudine Treated Chronic Hepatitis B at Siriraj Hospital

Author :
Chanunta Hongthanakorn, M.D.
Tawesak Tanwandee, M.D.

Abstract :

                  Lamivudine is the first of oral agent approved for the treatment of chronic hepatitis B and has demonstrated efficacy for both hepatitis B e positive and negative chronic hepatitis B patients.  One major problem of lamivudine treatment is the high proportion of post-treatment hepatitis flare that makes withdrawal of the drug to be very difficult.  Another problem is the development of YMDD mutation in C domain during treatment.  We retrospectively analyzed 114 Thai patients with chronic HBV infection after cessation of lamivudine treatment at Siriraj hospital.  All patients were administered 7 with 5-150 mg of lamivudine per day for >6 months.  Treatment was withdrawn in patients who had either HBe seroconversion or undetectable hepatitis B virus (HBV) DNA level together with normal aminotransferases.  For chronic hepatitis HBeAg positive patients, 35 patients (50.7%) relapsed after stopping lamivudine treatment at 8.4+5.7 months (range 1.8-24.8 months).  Threety-four (49.3%) patients who sustained HBeAg seroconversion after stopping lamivudine were followed for 18.5 +/- 14.3 (mean +/- SD) months (range 1.4-56.3 months).  We found the cumulative relapse rate in patients after post-treatment at 1 and 2 years were 35.7% and 59%, respectively.  For HBeAg negative patients, 20 (45%) patients relapsed at a mean duration of 10.2 +/- 11.2 months (range 1.6-44.3 months) after stopping treatment.  Those 24 (55%) patients who sustained responded were followed at a mean of 19.0 +/- 15.1 months (range 1.9 +/- 48.5 months).  We found the cumulative relapse rate in patients after post-treatment at 1 and 2 years were 38% and 47%, respectively.  In conclusion, these results demonstrated that responses in both e positive and e negative chronic hepatitis B by lamivudine were not durable in this endemic area.

[Thai J Gastroenterol 2006; 7(3): 143-150]

Keyword :
lamivudine, chronic hepatitis B, flares

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