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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
Kim, Yoon Jun; Kim, Byeong Gwan; Jung, Jun-Oh; Yoon, Jung-Hwan; Lee, Hyo-Suk
Issue Date
2006-05-16
Publisher
Springer Verlag
Citation
J Gastroenterol. 2006 Mar;41(3):240-9.
Keywords
AdolescentAdultAgedAlanine Transaminase/blood/drug effectsBilirubin/bloodBiological Markers/bloodDNA, Viral/blood/drug effectsDisease ProgressionDrug Resistance, Viral/*drug effectsFemaleFollow-Up StudiesHepatitis B e Antigens/blood/drug effectsHepatitis B virus/drug effects/metabolismHepatitis B, Chronic/blood/drug therapy/epidemiology/virologyHumansKorea/epidemiologyLamivudine/adverse effects/*therapeutic useLiver Failure/blood/*epidemiology/*physiopathologyMaleMiddle AgedMultivariate AnalysisMutation/*drug effectsPlatelet CountPredictive Value of TestsProspective StudiesProthrombin TimeReverse Transcriptase Inhibitors/adverse effects/*therapeutic useRisk FactorsSerum 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

http://hdl.handle.net/10371/29095
DOI
https://doi.org/10.1007/s00535-005-1750-5
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College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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