Lamivudine
Prevents HBV Reactivation in Immunosuppressed Patients
Lamivudine
(Epivir-HBV) is one of the most commonly used approved antiviral therapies
to treat chronic hepatitis B. It is also used
as prophylaxis to reduce the risk of vertical transmission to babies of HBV-infected
mothers and to prevent reinfection of the new liver after a transplant.
According
to a report in the February 2008 Journal of Viral Hepatitis, lamivudine
may also help prevent reactivation of HBV following immunosuppressive therapy.
Israeli
researchers performed a meta-analysis to assess the effect of prophylactic lamivudine
on reactivation and mortality following immunosuppressive therapy in hepatitis
B surface antigen (HBsAg) positive individuals. The systematically reviewed randomized
and non-randomized prospective controlled clinical trials and retrospective comparative
case series identified through the Cochrane Hepato-Biliary Group Controlled Trials
Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE,
and LILACS. A total of 21 studies were included, 2 of which were randomized controlled
trials.
The primary outcomes of interest were HBV virological reactivation,
clinical reactivation, and mortality. Secondary outcomes included hepatitis B-related
mortality, liver histology, discontinuation or disruption of immunosuppressive
therapy, lamivudine-resistant HBV strains, and adverse events.
Results
•
Clinical
reactivation was significantly reduced in patients taking lamivudine (odds ratio
[OR] 0.09; 95% CI 0.05-0.15).
•
The
same was true for virological reactivation (OR 0.04; 95% CI 0.01-0.14).
•
All-cause
mortality was significantly reduced in the lamivudine patients (OR 0.36; 95% CI
0.23-0.56).
•
This
translated to just 11 patients need to be treated to prevent 1 death.
•
Lamivudine
significantly reduced HBV-related mortality and discontinuation or disruption
of the immunosuppressive treatment.
•
No
adverse effects of lamivudine were reported.
•
Lamivudine
resistance occurred at low rates.
Conclusion
"We
demonstrated a clear benefit of lamivudine in terms of clinical and virological
HBV reactivation, overall mortality, HBV-related mortality, and interruptions
or discontinuations in the immunosuppressive treatment," the authors concluded.
"Lamivudine should be administered prophylactically to HBsAg-positive patients
who are about to receive immunosuppressive therapy."
Rabin Medical
Center, Petah-Tiqva, Israel; Tel-Aviv Unviersity, Ramat-Aviv, Tel-Aviv, Israel.
1/29/08
Reference LH
Katz, A Fraser, A Gafter-Gvili, and others. Lamivudine prevents reactivation of
hepatitis B and reduces mortality in immunosuppressed patients: systematic review
and meta-analysis. Journal of Viral Hepatitis 15(2): 89-102. February 2008.
