Long Term Responses Are Possible with Epivir-HBV

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Long Term Responses Are Possible with Epivir-HBV (lamivudine) Treatment of Hepatitis B

By Brian Boyle, MD

The goal of treatment of chronic hepatitis B virus (HBV) infection is to achieve prolonged suppression of HBV replication and a durable therapeutic response. One indicator of therapeutic response, loss of hepatitis B e antigen (HBeAg), is associated with multi-log reductions in circulating HBV DNA levels and an improvement in morbidity and mortality.

This response is associated with long-term clinical remission but not virologic cure since HBV DNA remains detectable in serum and hepatic tissue even after HBeAg loss/seroconversion.

In a study published in Hepatology, investigators evaluated the durability of serologic responses in 40 patients with HBV who experienced HBeAg seroconversion during Epivir-HBV (lamivudine) therapy. The patients were participants in studies involving Epivir-HBV and following the completion of the studies they were evaluated on a regular basis for HBeAg, hepatitis B surface antigen (HBsAg), HBV DNA, and alanine aminotransferase (ALT).

After a median of 36.6 months of follow-up, 77% and 23% of the patients remained HBeAg and HBsAg negative, respectively. Further, of the 23 patients that had a baseline undetectable HBV DNA and a normal ALT, 74% maintained these responses at the last visit. Of the 40 patients, 8 re-initiated treatment for HBV due to reappearance of HBV markers, and 7 showed biochemical and/or virologic improvement on re-initiation. Finally, there were no safety issues or adverse events in the patients studied.

The authors conclude, 搈ost patients with hepatitis B will experience a prolonged period of clinical benefit following HBeAg seroconversion and subsequent discontinuation of lamivudine therapy, and patients who experience reappearance of hepatitis B markers can be retreated to restore suppression of HBV replication. In a proportion of lamivudine-treated patients, long-term disease remission is attainable through a finite course of lamivudine monotherapy.?/span>

04/09/03

Reference
J Dienstag and others. Durability of Serologic Response After Lamivudine Treatment of Chronic Hepatitis B. Hepatology 2003;37:748-755.