title: Short-term corticosteroids then lamivudine and plasma exchanges to treat hepatitis B virus-related polyarteritis nodosa.
abstract: OBJECTIVE
  To assess the efficacy and safety of lamivudine, an antiviral agent that strongly inhibits hepatitis B virus (HBV) DNA replication, combined with plasma exchanges after short-term corticosteroids for HBV-related polyartertitis nodosa (PAN).
  
  
  METHODS
  Ten patients (8 men, 2 women, mean +/- SD age 50.4 +/- 14.4 years) with previously untreated HBV-related PAN were included in a multicenter, prospective, observational trial. Oral prednisone (1 mg/kg/day) was given for 1 week, then tapered and withdrawn within 1 week. Then, lamivudine (100 mg/day or less in the case of renal insufficiency) was started for a maximum of 6 months. Plasma exchanges were performed simultaneously and scheduled as follows: 3/week for 3 weeks, 2/week for 2 weeks, then 1/week until hepatitis B e antigen (HBeAg) to anti-HBe antibody (HBeAb) seroconversion was obtained or until 2-3 months of clinical recovery was sustained. The primary trial endpoint was clinical recovery from HBV-PAN at 6 months. The secondary endpoint was loss of detectable serum HBeAg and HBV DNA, and HBeAg to HBeAb seroconversion at 9 months.
  
  
  RESULTS
  One death, attributed to catheter-related septicemia, was recorded. At 6 months, all 9 survivors had achieved clinical recovery and by 9 months, 6 of 9 (66%) had seroconverted.
  
  
  CONCLUSIONS
  The strategy of short-term steroids followed by lamivudine and plasma exchanges effectively led to recovery from HBV-PAN. Because of its oral administration and good safety profile, lamivudine should henceforth be considered the antiviral agent of choice to treat HBV-related PAN.
authors.affiliation: Centre Hospitalier Universitaire Avicenne, Bobigny, France. loic.guillevin@cch.ap-hop-paris.fr
authors.forename: L
authors.initials: L
authors.lastname: Guillevin
authors.forename: A
authors.initials: A
authors.lastname: Mahr
authors.forename: P
authors.initials: P
authors.lastname: Cohen
authors.forename: C
authors.initials: C
authors.lastname: Larroche
authors.forename: V
authors.initials: V
authors.lastname: Queyrel
authors.forename: V
authors.initials: V
authors.lastname: Loustaud-Ratti
authors.forename: B
authors.initials: B
authors.lastname: Imbert
authors.forename: P
authors.initials: P
authors.lastname: Hausfater
authors.forename: J
authors.initials: J
authors.lastname: Roudier
authors.forename: P
authors.initials: P
authors.lastname: Bielefeld
authors.forename: P
authors.initials: P
authors.lastname: Petitjean
authors.forename: D
authors.initials: D
authors.lastname: Smadja
mesh_terms: D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D006509:Hepatitis B; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D010951:Plasma Exchange; D010488:Polyarteritis Nodosa / Q000628:therapy* / Q000821:virology*; D011241:Prednisone / Q000008:administration & dosage; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D011241:Prednisone; D008775:Methylprednisolone