Timing of lamivudine administration according to Child class in patients with decompensated cirrhosis.
BACKGROUND
Few clinical trials have investigated the use of lamivudine (LAM) in patients with decompensated cirrhosis related to chronic hepatitis B. The aim of the present study was to evaluate the efficacy of extended LAM treatment and to determine the timing of LAM administration in patients with decompensated cirrhosis.


METHODS
A total of 17 patients were treated with LAM 100 mg/day. The mean duration of follow up was 28 +/- 8.4 months (range: 14-42 months). All patients were evaluated for evidence of clinical, biochemical and serologic replication of hepatitis B virus (HBV) infection. There were 12 patients with Child class B and five with Child class C.


RESULTS
Ten of 17 patients (58.2%) responded to LAM treatment. Of the breakthrough patients, six (86%) had YMDD motif variants. Clinical improvement was observed in nine out of 10 responders (90%), six of the seven breakthrough patients (86%) and five of six patients with YMDD variant DNA. Mean time to achieve a 2-point reduction in Child-Pugh-Turcotte score was 14 months in patients with Child class C, compared with 5.9 months in those with Child class B (P < 0.001). Mean time required to gain a 0.5 g/dL increment in albumin was 14 months in Child class C and 5.8 months in Child class B. Hepatitis B e antigen (HBeAg) seroconversion was achieved in five of 13 HBeAg-positive patients at the last follow up and during the follow-up period.


CONCLUSIONS
Long-term administration of LAM for patients with decompensated cirrhosis is effective. Earlier LAM administration in Child class B patients led to improved clinical outcomes.
Bae
Si Hyun
SH
Department of Internal Medicine, Kangnam St. Mary's Hospital, Seoul, Korea.
Yoon
Seung Kew
SK
Choi
Jong Young
JY
Jang
Jeong Won
JW
Cho
Se Hyun
SH
Yang
Jin Mo
JM
Han
Nam Ik
NI
Ahn
Byung Min
BM
Chung
Kyu Won
KW
Sun
Hee Sik
HS
D000328:Adult; D004279:DNA, Viral / Q000097:blood / Q000235:genetics; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D014644:Genetic Variation; D006509:Hepatitis B / Q000150:complications / Q000821:virology; D006515:Hepatitis B virus / Q000235:genetics; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage* / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000503:physiopathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome
D004279:DNA, Viral; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine