title: Poor response to 18-month lamivudine monotherapy in chronic hepatitis B patients with IgM anti-HBc and acute exacerbation.
abstract: BACKGROUND
  Appearance of immunoglobulin class M antibody against hepatitis B core antigen is a predictor of beneficial response to interferon-alpha therapy in chronic hepatitis B patients, but its relationship with the efficacy of lamivudine therapy remains unclear.
  
  
  OBJECTIVE
  To investigate the outcome of lamivudine therapy in chronic hepatitis B patients with immunoglobulin class M antibody against hepatitis B core antigen and acute exacerbation.
  
  
  METHODS
  Chronic hepatitis B patients with acute exacerbation receiving a national-wide therapeutic trial of 18-month lamivudine monotherapy were enrolled for the analysis. Four consecutive seronegative patients were recruited as individual matching controls of one positive subject. Immunoglobulin class M antibody against hepatitis B core antigen in serum was assayed monthly by an automated microparticle enzyme immunoassay.
  
  
  RESULTS
  Fifteen (8.9%) of 167 chronic hepatitis B patients with acute exacerbation were seropositive for IgM anti-HBc. Thus 60 seronegative patients were consecutively recruited as control group. At the end of therapy, two (13.3%) of the 15 seropositive patients achieved a sustained response, significantly lower than 26 (43.3%) of the control group.
  
  
  CONCLUSIONS
  Appearance of immunoglobulin class M antibody against hepatitis B core antigen in chronic hepatitis B patients with acute exacerbation is a predictor of poor response to lamivudine monotherapy. This is clinically relevant to the decision-making in treating chronic hepatitis B patients with acute exacerbation.
authors.affiliation: Department of Internal Medicine, Chi-Mei Hospital Liouying, Taiwan.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Chen
authors.forename: C-Y
authors.initials: CY
authors.lastname: Lin
authors.forename: M-J
authors.initials: MJ
authors.lastname: Sheu
authors.forename: H-T
authors.initials: HT
authors.lastname: Kuo
authors.forename: C-S
authors.initials: CS
authors.lastname: Sun
authors.forename: L-Y
authors.initials: LY
authors.lastname: Tang
authors.forename: S-L
authors.initials: SL
authors.lastname: Wang
authors.forename: S-L
authors.initials: SL
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006510:Hepatitis B Antibodies / Q000097:blood; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007124:Immunoenzyme Techniques; D007075:Immunoglobulin M / Q000032:analysis; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D007075:Immunoglobulin M; D019259:Lamivudine