High Doses of Lamivudine Effective in Patients with HBV-Related Cirrhosis

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High Doses of Lamivudine Effective in Patients with HBV-Related Cirrhosis

The antiviral lamivudine (Epivir-HBV) has fallen out of favor as an antiviral treatment for hepatitis B because it causes drug resistance.

However, a study reported in the Digestive Diseases and Sciences found the antiviral was effective when administered in high doses in patients with cirrhosis.

Researchers treated six people with HBV-related cirrhosis with lamivudine doses raised from the normal dose of 100 mg daily to 200 or 300 mg daily, based on their viral load. Previously, nearly all of these patients had developed lamivudine resistance at the lower, 100 mg-dose, and had failed to improve even after the antiviral adefovir (Hepsera) (10 mg daily) was added to their ongoing lamivudine treatment.

The HBeAg-negative patients continued to receive adefovir, but the lamivudine dose was hiked for 12 months. All achieved a “significant” decrease in HBV DNA, three of the patients achieved undetectable viral load within six months. All achieved normal ALT levels, indicating no liver damage. The higher dose did not adversely impact their kidney function, nor were any other side effects noted.

The researchers suggested that increased doses of any antiviral—not just lamivudine—may be effective in hard-to-treat patients with life-threatening cirrhosis or liver damage.

HBV J November 2011