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Treatment of severe, nonfulminant acute hepatitis B with lamivudine vs placebo: a prospective randomized double‐blinded multicentre trial
Author(s) -
Wiegand J.,
Wedemeyer H.,
Franke A.,
Rößler S.,
Zeuzem S.,
Teuber G.,
Wächtler M.,
Römmele U.,
Ruf B.,
Spengler U.,
Trautwein C.,
Bock C. T.,
Fiedler G. M.,
Thiery J.,
Manns M. P.,
Brosteanu O.,
Tillmann H. L.
Publication year - 2014
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.12210
Subject(s) - lamivudine , medicine , hbsag , placebo , gastroenterology , hepatitis b virus , hepatitis b , clinical endpoint , adverse effect , randomized controlled trial , immunology , virus , pathology , alternative medicine
Summary Acute hepatitis B virus (a HBV ) infection can lead to fulminant liver failure, which likely is prevented by early lamivudine therapy. Even nonfulminant but severe acute hepatitis B can lead to significant morbidity and impaired quality of life. Therefore, lamivudine was evaluated in patients with severe a HBV in a placebo‐controlled trial. Patients with severe a HBV infection ( ALT >10× ULN , bilirubin >85 μ m , prothrombin time >50%) were prospectively treated with lamivudine 100 mg/day or with placebo within 8 days after the diagnosis. The primary end point was time to bilirubin <34.2 μ m . Secondary end points were time to clear HB sAg and HBV ‐ DNA , development of anti‐ HB s and normalization of ALT . Eighteen cases were randomized to lamivudine, 17 to placebo. 94% of patients were hospitalized. No individual progressed to hepatic failure; all but one patient achieved the primary end point. Due to smaller than expected patient numbers, all study end points did not become statistically significant between treatment arms. Median time end points [in days] were bilirubin <34.2 μ m (26.5 vs 32), ALT normalization (35 vs 48) and HB s A g clearance (48 vs 67) referring to earlier recovery under lamivudine, in contrast to loss of HBV ‐ DNA (62 vs 54) and development of anti‐ HB s (119 vs 109). In all but two patients (one in every group), HB s A g clearance was reached in the study. Adverse events occurred more frequently during lamivudine therapy, but did not reach statistical significance. Lamivudine may ameliorate severe a HBV infection, but limited patient numbers prevented definite conclusions.