title: Treatment of severe, nonfulminant acute hepatitis B with lamivudine vs placebo: a prospective randomized double-blinded multicentre trial.
abstract: Acute hepatitis B virus (aHBV) infection can lead to fulminant liver failure, which likely is prevented by early lamivudine therapy. Even nonfulminant but severe acute hepatitis B can lead to significant morbidity and impaired quality of life. Therefore, lamivudine was evaluated in patients with severe aHBV in a placebo-controlled trial. Patients with severe aHBV infection (ALT >10× ULN, bilirubin >85 μm, prothrombin time >50%) were prospectively treated with lamivudine 100 mg/day or with placebo within 8 days after the diagnosis. The primary end point was time to bilirubin <34.2 μm. Secondary end points were time to clear HBsAg and HBV-DNA, development of anti-HBs and normalization of ALT. Eighteen cases were randomized to lamivudine, 17 to placebo. 94% of patients were hospitalized. No individual progressed to hepatic failure; all but one patient achieved the primary end point. Due to smaller than expected patient numbers, all study end points did not become statistically significant between treatment arms. Median time end points [in days] were bilirubin <34.2 μm (26.5 vs 32), ALT normalization (35 vs 48) and HBsAg clearance (48 vs 67) referring to earlier recovery under lamivudine, in contrast to loss of HBV-DNA (62 vs 54) and development of anti-HBs (119 vs 109). In all but two patients (one in every group), HBsAg clearance was reached in the study. Adverse events occurred more frequently during lamivudine therapy, but did not reach statistical significance. Lamivudine may ameliorate severe aHBV infection, but limited patient numbers prevented definite conclusions.
authors: Universitätsklinikum Leipzig, Klinik für Gastroenterologie und Rheumatologie, Leipzig, Germany.
authors: J
authors: J
authors: Wiegand
authors: H
authors: H
authors: Wedemeyer
authors: A
authors: A
authors: Franke
authors: S
authors: S
authors: Rößler
authors: S
authors: S
authors: Zeuzem
authors: G
authors: G
authors: Teuber
authors: M
authors: M
authors: Wächtler
authors: U
authors: U
authors: Römmele
authors: B
authors: B
authors: Ruf
authors: U
authors: U
authors: Spengler
authors: C
authors: C
authors: Trautwein
authors: C T
authors: CT
authors: Bock
authors: G M
authors: GM
authors: Fiedler
authors: J
authors: J
authors: Thiery
authors: M P
authors: MP
authors: Manns
authors: O
authors: O
authors: Brosteanu
authors: H L
authors: HL
authors: Tillmann
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001663:Bilirubin / Q000097:blood; D004279:DNA, Viral / Q000097:blood; D004311:Double-Blind Method; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000473:pathology; D006509:Hepatitis B / Q000188:drug therapy*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000302:isolation & purification; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D010919:Placebos / Q000008:administration & dosage*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D010919:Placebos; D019259:Lamivudine; D000410:Alanine Transaminase; D001663:Bilirubin
keywords: acute liver failure; entecavir; fulminant hepatitis B; telbivudine; tenofovir