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High rates of progressive hepatic functional deterioration whether lamivudine therapy is continued or discontinued after emergence of a lamivudine-resistant mutant: a prospective randomized controlled study
Cited 2 time in
Web of Science
Cited 3 time in Scopus
- Authors
- Issue Date
- 2006-05-16
- Publisher
- Springer Verlag
- Citation
- J Gastroenterol. 2006 Mar;41(3):240-9.
- Keywords
- Adolescent ; Adult ; Aged ; Alanine Transaminase/blood/drug effects ; Bilirubin/blood ; Biological Markers/blood ; DNA, Viral/blood/drug effects ; Disease Progression ; Drug Resistance, Viral/*drug effects ; Female ; Follow-Up Studies ; Hepatitis B e Antigens/blood/drug effects ; Hepatitis B virus/drug effects/metabolism ; Hepatitis B, Chronic/blood/drug therapy/epidemiology/virology ; Humans ; Korea/epidemiology ; Lamivudine/adverse effects/*therapeutic use ; Liver Failure/blood/*epidemiology/*physiopathology ; Male ; Middle Aged ; Multivariate Analysis ; Mutation/*drug effects ; Platelet Count ; Predictive Value of Tests ; Prospective Studies ; Prothrombin Time ; Reverse Transcriptase Inhibitors/adverse effects/*therapeutic use ; Risk Factors ; Serum Albumin/drug effects/metabolism
- Abstract
- BACKGROUND: The management of patients with lamivudine-resistant mutants remains challenging, and no clear evidence has been presented concerning the discontinuation of lamivudine. METHODS: Seventy-four patients with lamivudine-resistant mutants were prospectively enrolled and randomized; 37 patients continued (group A) and 37 patients discontinued lamivudine therapy (group B). The median follow-up was 20 months. RESULTS: Serum albumin levels were reduced and prothrombin time was prolonged in both groups versus baseline (P = 0.015 and 0.045, respectively). Four patients in group A (10.8%) and six in group B (16.2%) experienced hepatitis flare, but the difference was not significant (P > 0.05). Multivariate analyses identified a younger age as a risk factor for hepatitis flare (P = 0.021). Seven (18.9%) decompensations occurred in group A and five (13.5%) in group B, which was not a significant difference (P > 0.05). Multivariate analyses revealed higher alanine aminotransferase and a lower platelet count as risk factors for hepatic decompensation (P = 0.001 and 0.001, respectively). The patients whose platelet count was <65 000/microl experienced hepatic decompensations more frequently (50%) than those with platelet counts >65 000/microl (13.2%) during follow-up (P = 0.05). CONCLUSIONS: The clinical course of group B was not significantly different from that of group A. Therefore, the discontinuation of lamivudine may be a feasible option when other antiviral agents active against lamivudine-resistant mutants are unavailable.
- ISSN
- 0944-1174 (Print)
- Language
- English
- URI
- http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16699858
https://hdl.handle.net/10371/29095
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