|
Most
Patients with Low Baseline HBV Viral Load Can Safely Discontinue
Lamivudine (Epivir-HBV) after Achieving Virological Suppression
| Most
chronic hepatitis B patients with low pre-treatment
HBV DNA levels (< 108
copies/mL) can maintain virological suppression
after discontinuing treatment with lamivudine
(Epivir-HBV), but relapse of hepatitis B "e"
antigen (HBeAg) negative hepatitis remains a concern,
according to a study published in the June
2009 Journal of Clinical Virology. |
|
Lamivudine
effectively suppresses HBV viral load, but it is unclear how
long treatment should be continued to achieve optimal long-term
outcomes.
The
ACT-HBV clinical trials Asia-Pacific Steering Committee recommended
withdrawal of lamivudine after patients achieve sustained
virological suppression. Chau-Ting Yeh and colleagues from
Taiwan analyzed outcomes among patients treated according
to this guideline.
The
study included 71 initially chronic hepatitis B patients who
maintained virological suppression and achieved HBeAg seroconversion
while on lamivudine monotherapy. Lamivudine was discontinued
if undetectable HBV DNA was documented on 2 separate occasions
at least 6 months apart.
Participants
were followed for a median of 15 months (range 6-72 months).
The researchers analyzed the effect of pre-treatment clinical
and virological factors on time to HBV relapse.
Results
 |
Of
the 71 patients, 19 (27%) experienced HBV relapse. |
|
Of
these, 5 exhibited reappearance of HBeAg, while 14 had
recurring HBeAg negative hepatitis. |
|
Pre-treatment
HBV DNA level was the only significant predictor of time
to relapse (hazard ratio 1.023; P = 0.020). |
|
15
of 34 patients (44.1%) with pre-treatment viral load >
108 copies/mL relapsed
during follow-up, compared with 4 of 37 patients (10.8%)
with pre-treatment HBV DNA < 108
copies/mL. |
|
This
difference in cumulative relapse rates between the 2 groups
was statistically significant (P = 0.003). |
Based
on these findings, the researchers concluded, "In patients
with pretreatment HBV DNA levels < 108
copies/mL, lamivudine could be withdrawn after achieving effective
maintained virological suppression.
However,
they added, "Relapse of HBeAg negative hepatitis remained
a major problem."
Liver
Research Unit, Chang Gung Memorial Hospital, Taipei, Taiwan;
Liver Cancer Research Center, Chang Gung University, Taoyuan,
Taiwan
10/09/09
Reference
C-T
Yeh, C-W Hsu, Y-C Chen, and others. Withdrawal of lamivudine
in HBeAg-positive chronic hepatitis B patients after achieving
effective maintained virological suppression. Journal of
Clinical Virology 45(2): 114-118. June 2009. (Abstract).
| 
