Sequential combination therapy of HBe antigen-negative/virus-DNA-positive chronic hepatitis B with famciclovir or lamivudine and interferon-alpha-2a
Article first published online: 1 APR 2004
Volume 24, Issue 2, pages 98–104, April 2004
How to Cite
Schiefke, I., Klecker, C., Maier, M., Oesen, U., Etzrodt, G., Tannapfel, A., Liebert, U. G. and Berr, F. (2004), Sequential combination therapy of HBe antigen-negative/virus-DNA-positive chronic hepatitis B with famciclovir or lamivudine and interferon-alpha-2a. Liver International, 24: 98–104. doi: 10.1111/j.1478-3231.2004.0889.x
- Issue published online: 1 APR 2004
- Article first published online: 1 APR 2004
- Received 14 March 2003, accepted 4 December 2003
- combination therapy;
- interferon alpha;
- nucleoside analogue;
- precore mutant chronic hepatitis B
Background/Aims: Hepatitis B e antigen-negative/hepatitis B virus (HBV) DNA-positive chronic hepatitis B (CHBe−) exhibits a high relapse rate on monotherapy with lamivudine or interferon-alpha (IFN-α). We investigated, whether sequential therapy with famciclovir or lamivudine followed by combination with IFN-α-2a improves durable virologic response in CHBe− characterized by mutation analysis of the HBV precore genome region.
Methods: Fourteen patients were treated with famciclovir (n=3) or lamivudine for 4 weeks to reduce the viral load, and subsequently with the combination of the nucleoside analogue and IFN-α-2a until 16 weeks beyond the loss of serum HBV-DNA.
Results: Median duration of therapy was 29.0 weeks (range 20.6–48.3 weeks). Serum HBV-DNA was undetectable and alanine aminotransferase had normalized in all patients at the end of treatment. Seven (50%) patients maintained a sustained response 12 months after end of treatment. Only two of them had been infected by HBV with the G1896A mutation. Most patients (5/7) with the G1896A mutation relapsed within 4 months after therapy.
Conclusion: Sequential combination therapy can induce sustained virologic response in a subgroup of CHBe−, but most with the G1896A precore mutant HBV relapse. Trials of CHBe− should be based on characterization of HBV mutants.