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Entecavir versus lamivudine for hepatitis B prophylaxis in patients with haematological disease

Authors

  • Fei W. Chen,

    1. Department of Gastroenterology, Royal North Shore Hospital, Sydney, Australia
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  • Luke Coyle,

    1. Department of Haematology, Royal North Shore Hospital, Sydney, Australia
    2. Sydney Medical School, University of Sydney, Sydney, Australia
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  • Brett E. Jones,

    1. Department of Gastroenterology, Royal North Shore Hospital, Sydney, Australia
    2. Sydney Medical School, University of Sydney, Sydney, Australia
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  • Venessa Pattullo

    Corresponding author
    1. Department of Gastroenterology, Concord Repatriation and General Hospital, Sydney, Australia
    2. Sydney Medical School, University of Sydney, Sydney, Australia
    • Department of Gastroenterology, Royal North Shore Hospital, Sydney, Australia
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Correspondence

Venessa Pattullo, Department of Gastroenterology, Royal North Shore Hospital, Pacific Highway, St Leonards NSW 2065, Australia

Tel: +61-2-9463 2450

Fax: +61-2-9463 2041

e-mail: venessa.pattullo@sydney.edu.au

Abstract

Background

Hepatitis B reactivation in patients receiving immunosuppressive therapy or chemotherapy may be associated with acute hepatitis, liver failure and/or death.

Aim

To audit the efficacy of entecavir as compared to lamivudine for the prophylaxis of HBV reactivation in patients with haematological disease receiving immunosuppression or chemotherapy.

Methods

Patients treated for haematological disease with pretreatment serological evidence of chronic hepatitis B (CHB) (HBV surface antigen, HBsAg positive) or resolved HBV infection (HBsAg negative but HBV core antibody positive) are included in this study. Patients received lamivudine 100 mg or entecavir 0.5 mg daily. Hepatitis B serology, HBV DNA and ALT were audited at baseline, 6 months, year 1, 2 and 3. HBV reactivation was defined as a 1 log increase in HBV DNA from baseline or reversion to sAg positivity. The occurrence of jaundice, symptomatic hepatitis, liver failure or death were audited.

Results

Of the 40 patients included in the study, 65% (4 CHB and 22 resolved HBV) received entecavir and 35% (11 CHB and 3 resolved HBV) received lamivudine. One patient with resolved HBV experienced HBV seroreversion related to premature cessation of entecavir. Eight patients with CHB (two from entecavir group and six from lamivudine group) had detectable HBVDNA levels at baseline; one case of HBV reactivation related to probable lamivudine resistance was identified. No HBV related deaths occurred.

Conclusion

Lamivudine and entecavir are both efficacious in the prophylaxis of hepatitis B reactivation. Entecavir should be used in preference to lamivudine in patients CHB with detectable baseline HBV DNA levels.

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