Cessation criterion in durability of lamivudine treatment

StephenW

<http://www3.interscience.wiley.com/journal/122598529/abstract>

Journal of Viral Hepatitis
Volume 17 Issue 4, Pages 298 - 304
Published Online: 15 Sep 2009
© 2010 Blackwell Publishing Ltd


Stringent cessation criterion results in better durability of lamivudine
treatment: a prospective clinical study in hepatitis B e antigen-positive
chronic hepatitis B patients

L. Wang 1 , F. Liu 2 , Y.-D. Liu 3 , X.-Y. Li 4 , J.-B. Wang 4 , Z.-H. Zhang 4
and Y.-Z. Wang 4

  1 Department of Infectious Diseases and Hepatology, the Second Hospital of
Shandong University, Shandong University, Jinan, China ;  2 Department of
Infectious Disease, Ruijin Hospital, Shanghai Jiao Tong University School of
Medicine, Shanghai, China ;  3 Yantai Infectious Disease Hospital, Yantai,
China ; and  4 Jinan Infectious Disease Hospital, Jinan, China

Correspondence to Wang Lei, Department of Infectious Diseases and Hepatology,
the Second Hospital of Shandong University, 247 Beiyuan Road, Jinan 250033,
China. E-mail: [email protected]

Copyright © 2010 Blackwell Publishing Ltd


ABSTRACT
Summary. The cessation criteria for lamivudine treatment vary in published
articles and their results are contradictory, especially factors predicting
relapse. To clarify these contradictions, this long-term follow-up study of
125 Chinese hepatitis B e antigen (HBeAg)-positive chronic hepatitis B
patients was designed with stringent cessation criterion. All patients
received lamivudine and achieved HBeAg seroconversion (group A, n = 82) or
loss (group B, n = 43) with undetectable hepatitis B virus (HBV) DNA by PCR
assay during the treatment. Lamivudine was withdrawn ≥6 months after HBeAg
seroconversion/loss occurred. The median treatment durations were 24 (12–54)
months and 36 (18–89) months in group A and group B, respectively. Patients
were followed up for median 24 (2–84) months. The cumulative relapse
(defined as serum HBV DNA ≥104 copies/mL) rates in the two groups at months
12, 24, 36 and 48 were 23.4%vs 35.0%, 25.0%vs 37.7%, 25.0%vs 41.1% and 29.4%vs
41.1%, respectively (log-rank test, P = 0.119). For patients whose total
treatment duration ≥18 months in group A, the cumulative relapse rates at
months 12, 24, 36 and 48 were 18.3%, 20.1%, 20.1% and 25.1%, which was
significantly lower than those with a shorter duration (log-rank test, P =
0.002). The mean age and median total duration were statistically different
between relapsers and nonrelapsers in group A (33.9 ± 13.6 vs 23.1 ± 11.0
years, P < 0.001 and 24 vs 26 months, P = 0.003). Cox regression revealed that
age was the only predictive factor for relapse (RR, 1.069; 95% CI,
1.032–1.106, P < 0.001). Patients aged <30 years relapsed less frequently in
5 years (12.3%vs 53.5%, P = 0.001). In conclusion, for patients who maintained
HBeAg seroconversion for ≥6 months and total duration for ≥18 months,
lamivudine withdrawal is a reasonable option. Prolonged treatment may be
required for patients aged greater than 30 years to reduce relapse.

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Received March 2009; accepted for publication May 2009
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1365-2893.2009.01178

bear2009

翻译下！看不懂！

人在乙途

也是，这年头都不用E了，看起来费力