Effect of Lamivudine (Epivir-HBV) and Adefovir Dipivoxil (Hepsera) on Preventing Hepatocellular Carcinoma

In a retrospective study presented at the recent 58th Annual Meeting of the American Association for the Study of Liver Diseases in Boston (November 2-6, 2007), South Korean researchers evaluated the effect of therapy with lamivudine (Epivir-HBV) and adefovir dipivoxil (Hepsera) on preventing hepatocellular carcinoma (HCC) in patients with hepatitis B-related liver cirrhosis.

The investigators reviewed the medical records of patients who were diagnosed with HBV-related liver disease at Yeungnam University hospital in South Korea between January 1983 and December 2005.

A total of 570 patients were treated with lamivudine over 12 months, and 284 were treated with adefovir after the emergence of lamivudine resistance between March 1997 and December 2005. In addition, 1592 individuals who could not be treated with oral antiviral agents between 1983 and 1999 were followed over 12 months. The mean follow-up period was 4.4 years in the oral antiviral agent group and 5.4 years in the control group.

In their findings using Cox regression model, 4 factors were related with HCC; gender (male, p<0.001), age (>40 years, p<0.001), platelet count (<150 X 103/mm3, p<0.001), and ascites (yes, p=0.009).

Using the SPSS program, 111 patients in the oral antiviral agent group and the untreated group were randomly selected, matched for age, sex, liver cirrhosis with Child-Pugh class A, and positive hepatitis B "e" antigen (HBeAg).

Results

• In the oral antiviral agent group, HCC occurred in 5 patients (4.5%), with an annual incidence rate of 1.02% patients per year.

• In the untreated control group, HCC occurred in 36 patients (32.4%), with an annual incidence rate of 6.0% patients per year.

• The cumulative incidence of HCC in the oral antiviral agent group was lower than that in the control group (P = 0.003) [see Figure 1].

Figure 1: Cumulative Incidence of HCC in Treated and Control Groups of HBeAg Positive Patients with HBV-Related Liver Cirrhosis

Conclusion

The study authors concluded that oral antiviral agents, such as lamivudine and adefovir, may reduce the incidence of HCC in patients with HBV-related liver cirrhosis.

Yeungnam University College of Medicine, Daegu, South Korea.

12/07/07

Reference
J Eun, H Lee, S Lee, and others. The effect of lamivudine and adefovir dipivoxil on preventing hepatocellular carcinoma in hepatitis B virus-related liver cirrhosis. 58th Annual Meeting of the American Association for the Study of Liver Diseases. Boston, MA, November 2-6, 2007. Abstract 961.