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Comparative Study
. 2012;9(1):27-32.
doi: 10.7150/ijms.9.27. Epub 2011 Nov 10.

Efficacy of lamivudine or entecavir on acute exacerbation of chronic hepatitis B

Tatsuo Kanda  1 , Masami Shinozaki, Hidehiro Kamezaki, Shuang Wu, Shingo Nakamoto, Makoto Arai, Keiichi Fujiwara, Nobuaki Goto, Fumio Imazeki, Osamu Yokosuka
Affiliations
Comparative Study

Efficacy of lamivudine or entecavir on acute exacerbation of chronic hepatitis B

Tatsuo Kanda et al. Int J Med Sci. 2012.

Abstract

Background/aims: Spontaneous acute exacerbation of chronic hepatitis B virus (HBV) infection occasionally occurs in its natural history, sometimes leading rapidly to fatal hepatic failure. We compared the effects of lamivudine (LAM) with those of entecavir (ETV) treatments in acute exacerbation of chronic hepatitis B with 500 IU/L or higher alanine aminotransferase (ALT) levels.

Methods: Thirty-four patients with acute exacerbation were consecutively treated with LAM /ETV. Their clinical improvements were compared.

Results: Among LAM-treated and ETV-treated patients, none showed a reduction of <1 log IU/mL in HBV DNA after 1 or 3 months of treatment. Initial virological response, defined as a reduction of 4 log IU/mL in HBV DNA at 6 months, with LAM and ETV, respectively, was 83.3% and 100%. One LAM patient developed hepatic encephalopathy, but all patients in both groups survived. Twelve months after treatment, 41.6% of 24 LAM group patients switched to another drug or added adefovir to their treatment due to the emergence of LAM-resistant mutants. On the other hand, patients receiving ETV did not need to change drugs.

Conclusions: ETV appears to be as effective as LAM in the treatment of patients with acute exacerbation of chronic hepatitis B. Clinicians should carefully start to treat these patients as soon as possible.

Keywords: ALT; HBV; acute exacerbation; entecavir; lamivudine.

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Conflict of interest statement

CONFLICT OF INTEREST: The authors have declared that no conflict of interest exists.

Figures

Figure 1
Figure 1
Initial virological response (IVR). IVR was defined as a reduction of ≥ 4 log IU/mL in HBV DNA after 6 months of therapy .
Figure 2
Figure 2
Efficacy of lamivudine and entecavir for ALT levels. Lamivudine (N=24) vs. entecavir (N=10); data are shown as mean ± SD.
Figure 3
Figure 3
Efficacy of lamivudine and entecavir for ALT levels in HBeAg-positive patients. Lamivudine (N=18) vs. entecavir (N=4); data are shown as mean ± SD.
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