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Timing of lamivudine administration according to Child class in patients with decompensated cirrhosis

Authors

  • SI HYUN BAE,

    1. Department of Internal Medicine, Kangnam St. Mary's Hospital and
    2. World Health Organization Collaborating Center for Reference and Research on Viral Hepatitis of Korea, Seoul, Korea
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  • SEUNG KEW YOON,

    1. Department of Internal Medicine, Kangnam St. Mary's Hospital and
    2. World Health Organization Collaborating Center for Reference and Research on Viral Hepatitis of Korea, Seoul, Korea
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  • JONG YOUNG CHOI,

    Corresponding author
    1. Department of Internal Medicine, Kangnam St. Mary's Hospital and
    2. World Health Organization Collaborating Center for Reference and Research on Viral Hepatitis of Korea, Seoul, Korea
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  • JEONG WON JANG,

    1. Department of Internal Medicine, Kangnam St. Mary's Hospital and
    2. World Health Organization Collaborating Center for Reference and Research on Viral Hepatitis of Korea, Seoul, Korea
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  • SE HYUN CHO,

    1. St. Mary's Hospital, College of Medicine, Catholic University of Korea and
    2. World Health Organization Collaborating Center for Reference and Research on Viral Hepatitis of Korea, Seoul, Korea
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  • JIN MO YANG,

    1. St. Mary's Hospital, College of Medicine, Catholic University of Korea and
    2. World Health Organization Collaborating Center for Reference and Research on Viral Hepatitis of Korea, Seoul, Korea
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  • NAM IK HAN,

    1. St. Mary's Hospital, College of Medicine, Catholic University of Korea and
    2. World Health Organization Collaborating Center for Reference and Research on Viral Hepatitis of Korea, Seoul, Korea
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  • BYUNG MIN AHN,

    1. St. Mary's Hospital, College of Medicine, Catholic University of Korea and
    2. World Health Organization Collaborating Center for Reference and Research on Viral Hepatitis of Korea, Seoul, Korea
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  • KYU WON CHUNG,

    1. St. Mary's Hospital, College of Medicine, Catholic University of Korea and
    2. World Health Organization Collaborating Center for Reference and Research on Viral Hepatitis of Korea, Seoul, Korea
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  • HEE SIK SUN

    1. St. Mary's Hospital, College of Medicine, Catholic University of Korea and
    2. World Health Organization Collaborating Center for Reference and Research on Viral Hepatitis of Korea, Seoul, Korea
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Jong Young Choi, Department of Internal Medicine, Kangnam St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul 137-040, Korea. Email: jychoi@cmc.cuk.ac.kr

Abstract

Background:  Few clinical trials have investigated the use of lamivudine (LAM) in patients with decompensated cirrhosis related to chronic hepatitis B. The aim of the present study was to evaluate the efficacy of extended LAM treatment and to determine the timing of LAM administration in patients with decompensated cirrhosis.

Methods:  A total of 17 patients were treated with LAM 100 mg/day. The mean duration of follow up was 28 ± 8.4 months (range: 14–42 months). All patients were evaluated for evidence of clinical, biochemical and serologic replication of hepatitis B virus (HBV) infection. There were 12 patients with Child class B and five with Child class C.

Results:  Ten of 17 patients (58.2%) responded to LAM treatment. Of the breakthrough patients, six (86%) had YMDD motif variants. Clinical improvement was observed in nine out of 10 responders (90%), six of the seven breakthrough patients (86%) and five of six patients with YMDD variant DNA. Mean time to achieve a 2-point reduction in Child–Pugh–Turcotte score was 14 months in patients with Child class C, compared with 5.9 months in those with Child class B (< 0.001). Mean time required to gain a 0.5 g/dL increment in albumin was 14 months in Child class C and 5.8 months in Child class B. Hepatitis B e antigen (HBeAg) seroconversion was achieved in five of 13 HBeAg-positive patients at the last follow up and during the follow-up period.

Conclusion:  Long-term administration of LAM for patients with decompensated cirrhosis is effective. Earlier LAM administration in Child class B patients led to improved clinical outcomes.

© 2005 Blackwell Publishing Asia Pty Ltd

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