Therapeutic Efficacy of Lamivudine in Patients With Hepatitis B Virus-Related Decompensated Cirrhosis in Korea

Jung, Saera; Suh, Dong Jin; Park, Hyun Ju; Park, Young Hwan; Song, Hee Gon; Lee, Han Chu; Chung, Young Hwa; Lee, Yung Sang

Abstract

BACKGROUND/AIMS: Although several clinical trials have suggested that lamivudine treatment can be very effective in patients with decompensated HBV-associated cirrhosis, its role and clinical efficacy are still uncertain because of the study designs. The aim of this study is to evaluate the efficacy of lamivudine in consecutively enrolled patients with decompensated cirrhosis. METHODS: Twenty-four patients with decompensated HBV-associated cirrhosis (Child-Pugh score >or=8) were enrolled consecutively and treated with lamivudine 100 mg or 150 mg daily for 2-51 months (median: 16 months). They were all positive for HBV DNA and 21 were positive for serum HBeAg. Eight were Child-Pugh class B and 16 were class C. Clinical improvement was defined as a decrease of Child-Pugh score of at least 2 points. RESULTS: At 6th month after lamivudine, all the patients cleared serum HBV DNA. The cumulative rates for HBeAg loss were 28.6% at 6th and 46.6% at 12th month. The cumulative viral breakthrough rates at 12th and 24th month were 20.0% and 37.5%. Fourteen patients (60.8%) showed clinical improvement, while 8 (34.8%) showed no change and 1 got worse, at 6th month after lamivudine. Most clinical improvement developed within the initial 6 months. The cumulative mortality rates were 20.8% at 1 year and 37.5% at 2 year. CONCLUSIONS: These data suggest that lamivudine can result in clinical improvement in about 60% of patients with HBV-related decompensated cirrhosis. Because most improvement occurrs within 6 months after starting lamivudine, liver transplantation should be actively considered in cases which do not show clinical improvement despite 6-month lamivudine treatment.