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Lamivudine for Chronic Hepatitis B

Last year, a study from Hong Kong showed that lamivudine leads to histologic and serologic improvement in patients with chronic hepatitis B (see JW Aug 1 1998, p. 123 and N Engl J Med 1998; 339:61). Now researchers report the results of a U.S. multicenter study in which 137 patients with chronic hepatitis B were randomized to lamivudine (100 mg per day orally) or placebo. All patients had chronic hepatitis on biopsy, as well as detectable serum hepatitis B virus (HBV) DNA and hepatitis B e antigen (HBeAg).

Patients in the lamivudine group were significantly more likely than placebo recipients to have a reduction in inflammatory activity (64 percent vs. 34 percent) and less likely to have progressive fibrosis (5 percent vs. 20 percent) on repeat liver biopsy after 1 year of treatment. HBeAg seroconversion was also significantly more likely with lamivudine (17 percent vs. 6 percent). Most lamivudine recipients had undetectable serum HBV DNA during the 1-year treatment phase, but 4 months after treatment was stopped, the median HBV DNA level had returned to about 50 percent of the pretreatment value. The authors report no major side effects.

Comment: Lamivudine clearly shows promise as a treatment for chronic hepatitis B. However, the optimal duration of therapy is unclear, and HBV DNA frequently reappears after the drug is stopped. Moreover, the ultimate impact on morbidity and mortality remains to be seen.

— AS Brett

Published in Journal Watch General Medicine October 26, 1999

Citation(s):

Dienstag JL et al. Lamivudine as initial treatment for chronic hepatitis B in the United States. N Engl J Med 1999 Oct 21 341 1256-1263.

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