Present address: Division of Transplant Hepatology, Universitätsklinikum Münster, Albert-Schweitzer-Str. 33, 48149 Münster, Germany.
Safety and efficacy of lamivudine in patients with severe acute or fulminant hepatitis B, a multicenter experience
Article first published online: 20 FEB 2006
Journal of Viral Hepatitis
Volume 13, Issue 4, pages 256–263, April 2006
How to Cite
Tillmann, H. L., Hadem, J., Leifeld, L., Zachou, K., Canbay, A., Eisenbach, C., Graziadei, I., Encke, J., Schmidt, H., Vogel, W., Schneider, A., Spengler, U., Gerken, G., Dalekos, G. N., Wedemeyer, H. and Manns, M. P. (2006), Safety and efficacy of lamivudine in patients with severe acute or fulminant hepatitis B, a multicenter experience. Journal of Viral Hepatitis, 13: 256–263. doi: 10.1111/j.1365-2893.2005.00695.x
- Issue published online: 20 FEB 2006
- Article first published online: 20 FEB 2006
- Received December 2004; accepted for publication April 2005
- fulminant hepatitis;
- hepatitis B;
- severe acute hepatitis;
Summary. Acute hepatitis B progresses to liver failure with the need of liver transplantation in about 1% of cases. We treated patients with severe acute or fulminant hepatitis B with lamivudine in an attempt to prevent hepatitis B virus (HBV) reinfection after potential liver transplantation. Since September 2000, 17 patients with severe acute or fulminant HBV infection were treated with 100 or 150 mg lamivudine daily once we had evidence for a severe course as indicated by an INR >2.0. These were compared to a historic control from our unit and to external patients. Fourteen of the 17 patients (82.4%) survived with full recovery without liver transplantation. All these 14 individuals cleared HBsAg on lamivudine within less than 6 months. Twelve patients recovered quickly as indicated by a normalized prothrombin time within 1 week while two patients had a more prolonged course. None of the patients showed an adverse event. Three patients requiring transplantation despite lamivudine therapy had more advanced disease on admission, of whom one had additionally ingested paracetamol (acetaminophen) while the second was already HBV-DNA negative by polymerase chain reaction on admission. The lamivudine treated patients had significant higher frequency of survival without liver transplantation 82.4 vs 20% (4/20) in the historic control (P < 0.001). Similar data were derived from external centres using lamivudine (15/20, 75%). Lamivudine is safe in patients with severe acute or fulminant hepatitis B, leading to fast recovery with the potential to prevent liver failure and liver transplantation when administered early enough.