标题: High Dose Lamivudine in HBV Cirrhotic Patients with Unsatisfactory Respon [打印本页] 作者: StephenW 时间: 2011-9-27 18:27 标题: High Dose Lamivudine in HBV Cirrhotic Patients with Unsatisfactory Respon
High Dose Lamivudine in HBV-Related Cirrhotic Patients with Unsatisfactory
Response After Adefovir Add-On Digestive Diseases and Sciences, 09/26/2011
Clinical Article
Montagnani M et al. – Rescue strategy with high–dose lamivudine
inhibited viral replication leading to undetectability of serum HBVDNA.
This rescue treatment presented a good safety profile, without adverse
events during the study period. Customized increase of nucleos(t)ide
analogues dose in difficult–to–treat patients may be a proficient
approach in challenging clinical setting.
Methods
6 patients with HBV-related liver cirrhosis were prospectively enrolled.
All were HBeAg-negative and presented a suboptimal response or virological
breakthrough after "adefovir add-on" because of development of clinical
breakthrough during Lamivudine treatment. Lamivudine dose was increased to
200 or 300mg, depending on viral load. After 12 months of follow-up,
virological and biochemical response were evaluated.
Results
After 12 months of high-dose lamivudine, all patients (6/6, 100%) achieved
a significant decrease of serum HBV DNA (mean reduction 2,62± 1,15 Log10
UI/ml, P=0.03) and normalized ALT. In three patients (3/6, 50%), HBV DNA
became undetectable within 6 months. No patient developed liver
decompensation and no significant changes occurred in serum creatinine,
serum and urinary electrolytes. No adverse events were registered.
<http://www.springerlink.com/content/j18vxg85x751862l/> Digestive Diseases
and Sciences DOI: 10.1007/s10620-011-1873-x
Original Article
High Dose Lamivudine in HBV-Related Cirrhotic Patients with Unsatisfactory
Response After Adefovir Add-On
Marco Montagnani, Marina Giandinoto, Andrea Lisotti, Silvia Galli,
Francesco Azzaroli, Federica Buonfiglioli, Laura Turco, Rita Aldini and
Giuseppe Mazzella Abstract Background
Before tenofovir approval for chronic hepatitis B therapy, the clinical
management of patients with suboptimal response or virological breakthrough
during combination treatment with lamivudine and adefovir dipivoxil was a
difficult clinical challenge.
Aims
In order to improve virologic response and reduce the risk of
decompensation, we evaluate the efficacy of a high dose of lamivudine on
chronic HBV patients who have previously presented an unsatisfactory
response during treatment with lamivudine 100mg/day and adefovir 10mg/day.
Methods
Six patients with HBV-related liver cirrhosis were prospectively enrolled.
All were HBeAg-negative and presented a suboptimal response or virological
breakthrough after "adefovir add-on" because of development of clinical
breakthrough during Lamivudine treatment. Lamivudine dose was increased to
200 or 300mg, depending on viral load. After 12 months of follow-up,
virological and biochemical response were evaluated.
Results
After 12 months of high-dose lamivudine, all patients (6/6, 100%) achieved
a significant decrease of serum HBV DNA (mean reduction 2,62 ± 1,15 Log10
UI/ml, P = 0.03) and normalized ALT. In three patients (3/6, 50%), HBV DNA
became undetectable within 6 months. No patient developed liver
decompensation and no significant changes occurred in serum creatinine,
serum and urinary electrolytes. No adverse events were registered.
Conclusions
In our experience, rescue strategy with high-dose lamivudine inhibited
viral replication leading to undetectability of serum HBVDNA. This rescue
treatment presented a good safety profile, without adverse events during
the study period. Customized increase of nucleos(t)ide analogues dose in
difficult-to-treat patients may be a proficient approach in challenging
clinical setting.