Systematic review: lamivudine prophylaxis for chemotherapy-induced reactivation of chronic hepatitis B virus infection
Article first published online: 12 SEP 2006
Alimentary Pharmacology & Therapeutics
Volume 24, Issue 7, pages 1003–1016, October 2006
How to Cite
KOHRT, H. E., OUYANG, D. L. and KEEFFE, E. B. (2006), Systematic review: lamivudine prophylaxis for chemotherapy-induced reactivation of chronic hepatitis B virus infection. Alimentary Pharmacology & Therapeutics, 24: 1003–1016. doi: 10.1111/j.1365-2036.2006.03081.x
- Issue published online: 12 SEP 2006
- Article first published online: 12 SEP 2006
- Publication data Submitted 2 June 2006 Accepted 5 July 2006
Background Reactivation of hepatitis B virus infection in asymptomatic hepatitis B surface antigen carriers undergoing chemotherapy or immunosuppressive therapy is a well-documented and potentially fatal complication. Data supporting the use of lamivudine for primary prophylaxis have emerged, but its use remains controversial and is not standardized.
Aim To review current randomized-controlled trials, randomized trials and prospective case series to provide a clinically applicable, evidence-based recommendation.
Methods The published literature was identified using a MEDLINE/PubMed search with secondary review of cited publications, and inclusion of all prospective studies.
Results In nine prospective trials and one randomized-controlled trial, the rate of hepatitis among subjects receiving lamivudine prophylaxis ranged from 0% to 20% (16 of 173, 9.2%), compared with 33–67% among controls. Of patients receiving prophylaxis, 0–24% (15 of 173, 8.7%) developed hepatitis B virus reactivation, compared with 29–56% of controls. Three reactivation-related mortalities were reported (one receiving prophylaxis, two controls). No patients withdrew secondary to toxicity or development of lamivudine-resistant mutations.
Conclusions The available data show a four- to sevenfold decrease in the rate of hepatitis and hepatitis B virus reactivation in patients who receive lamivudine prophylaxis. It is thus recommended that all hepatitis B surface antigen carriers receive lamivudine, or a comparable anti-viral agent, as prophylaxis from the initiation of chemotherapy until at least 1 year following its completion.