Early is superior to deferred preemptive lamivudine therapy for hepatitis B patients undergoing chemotherapy
| Autor: | Wing-Yan Au, Albert K. W. Lie, Raymond Liang, Roger K.C. Ngan, George K. K. Lau, Hai-ying Zhang, Harry H.Y Yiu, Lydia S.F Lai, Daniel Y. T. Fong, Micheal Cheung, Hoi-Ching Cheng |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Adult
Male Hepatitis B virus medicine.medical_specialty Time Factors medicine.medical_treatment medicine.disease_cause Antiviral Agents Gastroenterology law.invention Randomized controlled trial law Internal medicine medicine Humans Aged Aged 80 and over Hepatitis Chemotherapy Hepatology business.industry Incidence (epidemiology) Lamivudine Middle Aged Hepatitis B medicine.disease Virology Lymphoma DNA Viral Mutation Female Virus Activation business Follow-Up Studies medicine.drug |
| Zdroj: | Gastroenterology. 125:1742-1749 |
| ISSN: | 0016-5085 |
| Popis: | Background & Aims: Hepatitis B virus reactivation is a serious cause of morbidity and mortality in hepatitis B surface antigen-positive patients treated with chemotherapy. We compared the efficacy of early and deferred preemptive lamivudine therapy in reducing the incidence of hepatitis due to hepatitis B virus reactivation in hepatitis B surface antigen-positive lymphoma patients treated with chemotherapy.Methods: Thirty consecutive hepatitis B surface antigen-positive lymphoma patients undergoing intensive chemotherapy were randomized (1:1) to receive lamivudine 100 mg daily 1 week before chemotherapy (group 1) or to have this treatment deferred until there was serological evidence of hepatitis B virus reactivation on the basis of serial 2-week-interval serum hepatitis B virus DNA monitoring by a Digene Hybrid Capture II assay (group 2).Results: Eight (53%) patients in group 2 and none in group 1 had hepatitis B virus virological reactivation after chemotherapy ( P = 0.002). Seven patients in group 2 still had hepatitis (5 anicteric hepatitis, 1 icteric hepatitis, and 1 hepatic failure). Survival free from hepatitis due to hepatitis B virus reactivation in group 1 patients was significantly longer than that in group 2 ( P = 0.002 on the log-rank test). The median onset of hepatitis B virus reactivation in these patients was 16 weeks (range, 4–36 weeks) after the initiation of chemotherapy. Three (13%) of the 23 patients treated with lamivudine had hepatitis B virus-related hepatitis after lamivudine withdrawal.Conclusions: Lamivudine should be considered preemptively before or at the initiation of chemotherapy for all hepatitis B surface antigen-positive lymphoma patients undergoing intense chemotherapy. |
| Databáze: | OpenAIRE |
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