Treatment with lamivudine and entecavir in severe acute hepatitis B

Indian J Med Microbiol. 2016 Apr-Jun;34(2):166-72. doi: 10.4103/0255-0857.176837.

Abstract

Background: Severe acute hepatitis B (SAHB) is an insufficiently described clinical entity, with relatively scarce data on anti-viral therapy available in field literature.

Methods: We performed an open-label study to evaluate specific anti-viral therapy in SAHB in Bucharest, Romania, during 2005-2009. Patients were allocated to two treatment groups and one control group: Group 1 - lamivudine 100 mg/day, Group 2 - entecavir 0.5 mg/day and Group 3 - standard of care, without anti-viral therapy. The primary endpoint was hepatitis B surface antigen (HBsAg) to hepatitis B surface antibody (anti-HBs) seroconversion by 24 weeks. Additional analyses included assessment of HBsAg clearance and hepatitis B e antigen (HBeAg) to hepatitis B e antibody (anti-HBe) seroconversion.

Results: In Group 1, 7/69 patients (10.14%, P = 0.032) reached HBsAg/Ab seroconversion by 24 weeks, compared with 9/21 (42.85%, P = 0.053) in Group 2 and 25/110 (22.72%) in Group 3. HBsAg clearance by 24 weeks: 16/69 patients (23.18%, P = 0.027) in Group 1, 11/21 (52.38%, P = 0.256) in Group 2 and 43/110 (39.09%) in Group 3. HBeAg/Ab seroconversion: 46/61 (75.40%, P = 0.399) in Group 1, 9/19 (47.36%, P = 0.001) in Group 2 and 74/100 (74.00%) in Group 3.

Conclusion: Anti-viral therapy can be considered for managing selected cases of SAHB. Biochemical as well as virological parameters need to orient the choice of the anti-viral agent. Lamivudine displayed a greater decrease in viral load compared to controls, but it was associated with lower levels of HBsAg to anti-HBs seroconversion. Patients treated with entecavir showed a better response in terms of HBs seroconversion by 24 weeks.

Publication types

  • Clinical Study

MeSH terms

  • Adult
  • Antiviral Agents / administration & dosage*
  • Female
  • Guanine / administration & dosage
  • Guanine / analogs & derivatives*
  • Hepatitis B / drug therapy*
  • Hepatitis B Antibodies / blood
  • Hepatitis B Surface Antigens / blood
  • Humans
  • Lamivudine / administration & dosage*
  • Male
  • Middle Aged
  • Prospective Studies
  • Romania
  • Treatment Outcome
  • Viral Load

Substances

  • Antiviral Agents
  • Hepatitis B Antibodies
  • Hepatitis B Surface Antigens
  • Lamivudine
  • entecavir
  • Guanine