The effect of lamivudine therapy in hepatic decompensation during acute exacerbation of chronic hepatitis B.
OBJECTIVE
Severe acute exacerbation (AE) of chronic hepatitis B (CHB) can lead to hepatic decompensation and death. The aim of this study was to investigate the effect of lamivudine therapy in hepatic decompensation during such AEs.


METHODS
In a 10-month period, a total of 60 consecutive AE patients with jaundice and prolonged prothrombin time over 3s were treated with lamivudine 150 mg daily. As a historical control, another 31 CHB patients with AE resulting in hepatic decompensation hospitalized in an immediate past 6-month period were enrolled for comparison.


RESULTS
Patients in both groups were comparable in clinical and biochemical features. After a median treatment period of 6 weeks (range 1-48 weeks), all of the 25 patients with pretherapy bilirubin level < 20 mg/dl in the treatment group survived, while five (25%) of 20 patients in the control group died (P=0.013; odds ratios, 2.667; 95% confidence interval, 1.787-3.979). However, the mortality rate was similar in patients with pretherapy bilirubin level > or =20 mg/dl in both groups.


CONCLUSIONS
These results suggest that lamivudine may prevent fatality in CHB patients with hepatic decompensation if therapy starts early enough or before serum bilirubin level rise over 20 mg/dl, but helps little if serum level already risen over that level.
Chien
Rong-Nan
RN
Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University, 199 Tung Hwa North Road, Taipei, 105 Taiwan.
Lin
Chia-Hsien
CH
Liaw
Yun-Fan
YF
D000328:Adult; D001663:Bilirubin / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage / Q000627:therapeutic use*; D008099:Liver / Q000187:drug effects* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D016019:Survival Analysis
D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D001663:Bilirubin