Clinical Outcomes after Discontinuation of Lamivudine in Chronic Hepatitis B Patients with Lamivudine Resistant HBV Mutant

Korean J Hepatol > Volume 11(3); 2005 > Article

The Korean Journal of Hepatology 2005;11(3): 227-242.

Clinical Outcomes after Discontinuation of Lamivudine in Chronic Hepatitis B Patients with Lamivudine Resistant HBV Mutant

Jeong Ki Kim, M.D.1, Seong Gyu Hwang, M.D.1,2, Hyeuk Park, M.D.1, Hong Youp Choi, M.D.1, Hyo Jin Cho, B.S.2, Kwang Hyun Ko, M.D.1, Sung Pyo Hong, M.D.1, Pil Won Park, M.D.1, Nam Keun Kim, Ph.D.2, and Kyu Sung Rim, M.D.1,2

Department of Internal Medicine1 and Institute for Clinical Reserch2, College of Medicine, Pochon CHA University, Sungnam, Korea

ABSTRACT

Background/Aims
The therapeutic strategies of applying adefovir for treating lamivudine resistant HBV mutants are controversial. Thus, we observed the clinical outcomes after discontinuation of lamivudine to establish the timing to initiate adefovir therapy. Methods: Fifty chronic hepatitis B (CHB) patients with lamivudine resistant HBV mutants who had received lamivudine for more than 12 months were included in the study. We investigated the clinical outcomes at 6 months after the end of treatment (EOT). We compared the serial clinical outcomes among respective groups based on serum ALT at the EOT and the clinical characteristics of patients with or without acute exacerbation (AE) and the HBeAg loss. We also investigated the predictive parameters of AE and HBeAg loss. Results: Fifteen patients (30%) had experienced AE at 6 months after the EOT. Four patients received antiviral agents because of their hepatic decompensation. Patients with AE had higher serum ALT values and lower HBV DNA titers at EOT compared with those patients without AE. Serum ALT at the EOT was the predictive parameter of AE. Eight patients (21.6%) had newly developed HBeAg loss at 6 months after EOT. The total bilirubin at EOT was the predictive parameter of HBeAg loss. Conclusions: CHB patients with lamivudine resistant HBV mutants had favorable clinical outcomes at 6 months after EOT. Therefore, we can consider observing the clinical courses after discontinuation of lamivudine and it is not always required to overlap the adefovir for treating lamivudine resistant HBV mutants except for the treatment of patients with a high risk of developing decompensation. (Korean J Hepatol 2005;11:227-242)

KeyWords: Hepatitis/Viral hepatitis/Chronic hepatitis B, Lamivudine resistant HBV mutants, Adefovir