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Chinese Herbs Taken with Lamivudine May Reduce Hepatitis B Mortality


Hepatitis B patients who used traditional Chinese medicine, including the herbal preparation Jia-Wei-Xiao-Yao-San, while being treated with lamivudine (3TC or Epivir) were less likely to die of any cause than non-users, according to research published in the November 4, 2015, Journal of Enthopharmacology.

Nucleoside/nucleotide antivirals such as lamivudine, entecavir (Baraclude), and tenofovir (Viread) are the mainstay of hepatitis B treatment. Althou gh they usually do not produce a cure, sustained viral suppression on these drugs is associated with reduced liver disease progression and potentially reduced mortality. A variety of herbal remedies have been used in traditional Chinese medicine to treat liver diseases including viral hepatitis.

Der-Shiang Tsai from China Medical University in Taichung, Taiwan, and colleagues evaluated the effects of Chinese herbal medicines in patients with chronic hepatitis B virus (HBV) infection who were treated with lamivudine, which can loose its effectiveness over time due to drug resistance. Pharmacological studies in cell and animal models suggest that Chinese herbal medicines can have an anti-HBV effect, they noted as background.

In particular, they looked at the combination formula Jia-Wei-Xiao-Yao-San (JWXYS), containing bupleurum, peony, and other herbs, which is traditionally used for liver conditions.

This analysis looked at 1037 adult hepatitis B patients treated with lamivudine in the Taiwan National Health Insurance Research Database, which includes most Taiwanese residents covered by the national healthcare system. The study lasted from 2004 through 2011, with a median follow-up duration of 5.3 years. During the study period about half (49%) of the participants used Chinese herbal medicines, with a median duration of 2.4 years of use.


  • A total of 88 deaths were recorded among the 1037 patients during the study period, for an overall all-cause mortality rate of 8.5%.
  • 21 people who used Chinese herbal medicines died during follow-up, compared to 67 non-users.
  • Chinese herbal medicine users had significantly lower all-cause mortality than non-users (adjusted hazard ratio 0.45, or 55% risk reduction).
  • Use of JWXYS specifically was also associated with reduced all-cause mortality (adjusted HR 0.26).
  • Older age and chronic kidney disease were also independent predictors of all-cause mortality.

Based on these findings, the authors concluded, "This study reveals that the use of Chinese herbal medicines may lower the risk of death in patients with chronic hepatitis B receiving lamivudine treatment. Further randomized-controlled trials are required to validate these findings."



D-S Tsai, M-H Huang, Y-S Chang, et al. The use of Chinese herbal medicines associated with reduced mortality in chronic hepatitis B patients receiving lamivudine treatment. Journal of Ethnopharmacology 174:161-167. November 4, 2015.