Lamivudine monotherapy for spontaneous severe acute exacerbation of chronic hepatitis B.
BACKGROUND
Severe acute exacerbations of chronic hepatitis B virus (HBV) infection can spontaneously occur and rapidly progress to fatal hepatic failure. The purpose of the present paper was to identify factors that could influence the rapid progression of liver disease to hepatic failure, and assess the effects of lamivudine on serious disease.


METHODS
Twenty-five patients with spontaneous severe acute exacerbation (accompanied by jaundice and coagulopathy) were consecutively treated with lamivudine. Their clinical outcomes were compared with those of 25 lamivudine-untreated patients, as historical controls.


RESULTS
Six lamivudine-treated patients (24%)and seven controls (28%) rapidly developed hepatic failure. Lamivudine monotherapy did not significantly prevent progression to hepatic failure. Multivariate analysis identified baseline serum bilirubin >/=6 mg/dL (odds ratio [OR]: 5.61; 95% confidence interval [CI]: 1.66-21.61; P = 0.018), pre-existing cirrhosis (OR: 4.52; 95%CI: 1.26-30.42; P = 0.034), and baseline prothrombin time <40% (OR: 3.75; 95%CI: 1.03-43.86; P = 0.045) as independent determinants of the event. Of the aforementioned patients with hepatic failure, three lamivudine-treated patients (50%) and two controls (29%) survived (P > 0.15). However, lamivudine induced a sustained normalization of liver function and inhibited the development of cirrhosis in survivors.


CONCLUSIONS
Lamivudine monotherapy conferred no significant protection against rapid progression of the disease to hepatic failure, but it resulted in long-term benefits. Lamivudine combined with other drugs could be more beneficial for patients with the aforementioned risk factors.
Tsubota
Akihito
A
Department of Gastroenterology, Toranomon Hospital, Minato, Tokyo, Japan. atsubo@jikei.ac.jp
Arase
Yasuji
Y
Suzuki
Yoshiyuki
Y
Suzuki
Fumitaka
F
Sezaki
Hitomi
H
Hosaka
Tetsuya
T
Akuta
Norio
N
Someya
Takashi
T
Kobayashi
Masahiro
M
Saitoh
Satoshi
S
Ikeda
Kenji
K
Kumada
Hiromitsu
H
D000208:Acute Disease; D000284:Administration, Oral; D000328:Adult; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D004279:DNA, Viral / Q000097:blood; D018450:Disease Progression; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage / Q000627:therapeutic use*; D008099:Liver / Q000000981:diagnostic imaging; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D000637:Transaminases / Q000097:blood; D016896:Treatment Outcome; D014463:Ultrasonography
D015415:Biomarkers; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D000637:Transaminases; D001663:Bilirubin