Lamivudine Maintenance Beyond One Year After Hbeag... : Hepatology (original) (raw)

Viral Hepatitis

Lamivudine Maintenance Beyond One Year After Hbeag Seroconversion Is A Major Factor for Sustained Virologic Response in Hbeag-Positive Chronic Hepatitis B

Lee, Hyun Woong1,2,3; Lee, Heon Ju3,4; Hwang, Jae Seok3,5; Sohn, Joo Hyun3,6; Jang, Jae Young7; Han, Ki Jun8; Park, Jun Yong1,3,9; Kim, Do Young1,3,9; Ahn, Sang Hoon1,3,9; Paik, Yong Han1,3,9; Lee, Chun Kyon3,10; Lee, Kwan Sik1,3,9; Chon, Chae Yoon1,3,9; Han, Kwang-Hyub1,3,9,*

1_Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea_

2_Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea_

3_Liver Cirrhosis Clinical Research Center, Seoul, Korea_

4_Department of Internal Medicine, Yeungnam University College of Medicine, Seoul, Korea_

5_Department of Internal Medicine, Keimyung University School of Medicine, Seoul, Korea_

6_Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea_

7_Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea_

8_Department of Internal Medicine, Kwandong University College of Medicine, Seoul, Korea_

9_Department of Internal Medicine, Yonsei Institute of Gastroenterology, Seoul, Korea_

10_Department of Internal Medicine, National Health Institute Corporation Ilsan Hospital, Seoul, Korea_

*Address reprint requests to: Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaimun-gu, Seoul 120-752, Korea. Email:[email protected]; fax: 82-2-312-7833.

Received 30 January 2009; Accepted 10 September 2009

Published online 9 November 2009 in Wiley InterScience (www.interscience.wiley.com).

Supported by a grant (no. A050021) of the Good Health R&D Project, Ministry for Health, Welfare and Family Affairs, Republic of Korea.

Potential conflict of interest: Nothing to report.

Abstract

The reported durability of virologic response after successful lamivudine monotherapy is variable, and the question remains as to whether virologic responses can be maintained over an extended follow-up period. The aim of this study was to investigate posttreatment durability, the optimal duration of additional treatment after HBeAg clearance or seroconversion, and determinants for sustained virologic response (SVR) following lamivudine monotherapy in patients with HBeAg-positive chronic hepatitis B (CHB). From January 1999 to August 2004, 178 Korean patients with HBeAg-positive CHB were treated with lamivudine and achieved complete responses, defined as a loss of serum HBeAg and hepatitis B virus DNA, and alanine aminotransferase normalization. The mean duration of lamivudine monotherapy was 26 months (range, 12-77). SVR was maintained in 138 patients (77.5%). Host and viral factors were compared between 138 patients with SVR and 40 patients whose response was not sustained. The cumulative relapse rates increased from 15.9% at 1 year to 30.2% at 5 years, with a mean time to relapse after cessation of lamivudine of 12 months (range, 7-42). Most relapses occurred within 2 years after discontinuation of lamivudine (33/40, 82.5%). On multivariate analysis, age ≤40 years and additional treatment for more than 12 months after HBeAg clearance or seroconversion were independent factors for SVR. Conclusion: The lamivudine-induced virologic response was durable in patients under 40 years old and those receiving lamivudine for more than 12 months after HBeAg clearance or seroconversion. Age and additional treatment were major predictive factors for SVR. (Hepatology 2010.)