YMDD变异后拉米使用和停用的结果比较

zasxz

Comparison of Clinical Outcome Between Patients Continuing and Discontinuing Lamivudine Therapy after Breakthrough of YMDD Mutants


The aim of this study was to compare the clinical outcome between patients continuing and discontinuing lamivudine (Epivir-HBV) therapy after the biochemical breakthrough of hepatitis B virus tyrosine杕ethionine朼spartate朼spartate (YMDD) mutant.

YMDD mutants were detected in 51 chronic hepatitis B patients who experienced a flare-up of alanine aminotransferase (ALT) during lamivudine treatment.

Twenty-seven of them discontinued lamivudine therapy (group A), and 24 continued therapy (group B) after biochemical breakthrough. The follow-up period was 12 months in both the groups.

Results
There was no significant difference between groups A and B in the incidence and severity of ALT peaks and hepatic decompensation within the first 3 months after biochemical breakthrough.

After the fourth month of biochemical breakthrough, however, group A experienced acute exacerbation more frequently [20/26 (77%) vs. 7/23 (30%); P=0.002] and higher ALT peaks than group B.

The same result was found when the patients were divided into na飗e and retreated or cirrhotic and non-cirrhotic groups.

Hepatic decompensation at the onset of biochemical breakthrough was associated with higher mortality (OR=70, 95% CI=6.06?07.75).

Conclusions
Patients who discontinued lamivudine therapy increased the frequency of flare-ups and higher ALT peaks than those who continued therapy after 4 months post-breakthrough.

10/06/04

Reference
C H Chen and others. Comparison of clinical outcome between patients continuing and discontinuing lamivudine therapy after biochemical breakthrough of YMDD mutants. Journal of Hepatology 41(3): 454-461. September 2004.