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Systematic review: lamivudine prophylaxis for chemotherapy‐induced reactivation of chronic hepatitis B virus infection
Author(s) -
KOHRT H. E.,
OUYANG D. L.,
KEEFFE E. B.
Publication year - 2006
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2006.03081.x
Subject(s) - lamivudine , medicine , hepatitis b virus , randomized controlled trial , hepatitis b , chemotherapy , asymptomatic , immunology , gastroenterology , virus
Summary Background Reactivation of hepatitis B virus infection in asymptomatic hepatitis B surface antigen carriers undergoing chemotherapy or immunosuppressive therapy is a well‐documented and potentially fatal complication. Data supporting the use of lamivudine for primary prophylaxis have emerged, but its use remains controversial and is not standardized. Aim To review current randomized‐controlled trials, randomized trials and prospective case series to provide a clinically applicable, evidence‐based recommendation. Methods The published literature was identified using a MEDLINE/PubMed search with secondary review of cited publications, and inclusion of all prospective studies. Results In nine prospective trials and one randomized‐controlled trial, the rate of hepatitis among subjects receiving lamivudine prophylaxis ranged from 0% to 20% (16 of 173, 9.2%), compared with 33–67% among controls. Of patients receiving prophylaxis, 0–24% (15 of 173, 8.7%) developed hepatitis B virus reactivation, compared with 29–56% of controls. Three reactivation‐related mortalities were reported (one receiving prophylaxis, two controls). No patients withdrew secondary to toxicity or development of lamivudine‐resistant mutations. Conclusions The available data show a four‐ to sevenfold decrease in the rate of hepatitis and hepatitis B virus reactivation in patients who receive lamivudine prophylaxis. It is thus recommended that all hepatitis B surface antigen carriers receive lamivudine, or a comparable anti‐viral agent, as prophylaxis from the initiation of chemotherapy until at least 1 year following its completion.