Lamivudine maintenance beyond one year after HBeAg seroconversion is a major factor for sustained virologic response in HBeAg-positive chronic hepatitis B.
The reported durability of virologic response after successful lamivudine monotherapy is variable, and the question remains as to whether virologic responses can be maintained over an extended follow-up period. The aim of this study was to investigate posttreatment durability, the optimal duration of additional treatment after HBeAg clearance or seroconversion, and determinants for sustained virologic response (SVR) following lamivudine monotherapy in patients with HBeAg-positive chronic hepatitis B (CHB). From January 1999 to August 2004, 178 Korean patients with HBeAg-positive CHB were treated with lamivudine and achieved complete responses, defined as a loss of serum HBeAg and hepatitis B virus DNA, and alanine aminotransferase normalization. The mean duration of lamivudine monotherapy was 26 months (range, 12-77). SVR was maintained in 138 patients (77.5%). Host and viral factors were compared between 138 patients with SVR and 40 patients whose response was not sustained. The cumulative relapse rates increased from 15.9% at 1 year to 30.2% at 5 years, with a mean time to relapse after cessation of lamivudine of 12 months (range, 7-42). Most relapses occurred within 2 years after discontinuation of lamivudine (33/40, 82.5%). On multivariate analysis, age <or=40 years and additional treatment for more than 12 months after HBeAg clearance or seroconversion were independent factors for SVR.


CONCLUSIONS
The lamivudine-induced virologic response was durable in patients under 40 years old and those receiving lamivudine for more than 12 months after HBeAg clearance or seroconversion. Age and additional treatment were major predictive factors for SVR.
Lee
Hyun Woong
HW
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Lee
Heon Ju
HJ
Hwang
Jae Seok
JS
Sohn
Joo Hyun
JH
Jang
Jae Young
JY
Han
Ki Jun
KJ
Park
Jun Yong
JY
Kim
Do Young
DY
Ahn
Sang Hoon
SH
Paik
Yong Han
YH
Lee
Chun Kyon
CK
Lee
Kwan Sik
KS
Chon
Chae Yoon
CY
Han
Kwang-Hyub
KH
D000328:Adult; D000368:Aged; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
D006513:Hepatitis B e Antigens; D019259:Lamivudine