Systematic review: the effect of preventive lamivudine on hepatitis B reactivation during chemotherapy.
BACKGROUND
Lamivudine is increasingly being used to prevent hepatitis B reactivation in patients with cancer who test positive for hepatitis B surface antigen (HBsAg) and are undergoing chemotherapy.


OBJECTIVE
To determine whether preventive lamivudine reduces chemotherapy-induced hepatitis B virus (HBV)-related morbidity and mortality in patients with cancer who test positive for HBsAg.


METHODS
MEDLINE, Ovid MEDLINE, TOXNET, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were searched in all languages until June 2007.


METHODS
Clinical trials and cohort studies that reported the efficacy of preventive lamivudine versus control on HBV reactivation in patients who tested positive for HBsAg and were receiving chemotherapy were included. Additional requirements included minimum sample size (>5 participants per treatment group) and reported HBV-related morbidity and mortality data.


METHODS
Two investigators independently did literature searches and data extraction, and 2 other investigators independently confirmed study eligibility and data retrieval.


RESULTS
Fourteen studies (2 randomized, controlled trials; 8 prospective cohort studies; and 4 retrospective cohort studies) met the predefined criteria for analysis. There were 275 patients in the preventive lamivudine group and 475 control participants for the primary end point of HBV reactivation. With preventive lamivudine, the relative risk for both HBV reactivation and HBV-related hepatitis ranged from 0.00 to 0.21. None of the patients in the preventive lamivudine group developed HBV-related hepatic failure (0 of 108 patients vs. 21 of 162 patients), and only 4 deaths were attributable to HBV (4 of 208 patients vs. 27 of 394 patients) in the preventive lamivudine group. Lamivudine was well tolerated, and no adverse effects were noted.


CONCLUSIONS
The studies included in the meta-analysis did not consistently report all of the outcomes of interest. Sample sizes were small and only 2 studies had a randomized, controlled design.


CONCLUSIONS
Preventive therapy with lamivudine for patients who test positive for HBsAg and are undergoing chemotherapy may reduce the risk for HBV reactivation and HBV-associated morbidity and mortality.
Loomba
Rohit
R
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland 20892, USA. roloomba@ucsd.edu
Rowley
Ayana
A
Wesley
Robert
R
Liang
T Jake
TJ
Hoofnagle
Jay H
JH
Pucino
Frank
F
Csako
Gyorgy
G
D000970:Antineoplastic Agents / Q000009:adverse effects*; D000998:Antiviral Agents / Q000627:therapeutic use*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000517:prevention & control* / Q000821:virology; D006801:Humans; D016867:Immunocompromised Host; D019259:Lamivudine / Q000627:therapeutic use*; D017114:Liver Failure, Acute / Q000517:prevention & control; D009369:Neoplasms / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D014775:Virus Activation / Q000187:drug effects
D000970:Antineoplastic Agents; D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D019259:Lamivudine