It has been suggested that hepatitis B e antigen (HBeAg) seroconversion after lamivudine therapy is durable in Caucasians with chronic hepatitis B (CHB). However, little is known whether it is also durable in endemic areas of hepatitis B virus (HBV) infection. We evaluated the posttreatment durability of lamivudine-induced HBeAg seroconversion and the predictive factors for relapse in Korean patients with CHB. We retrospectively analyzed 98 HBeAg-positive patients with CHB who were treated with lamivudine between August 1996 and December 1997. Lamivudine was given at a dose of 150 mg per day. After HBeAg seroconversion, lamivudine was continued for an additional 2 to 4 months, and posttreatment monitoring continued for up to 24 months. HBeAg seroconversion was achieved in 34 of the 98 patients (34.7%). The mean duration of treatment in these seroconverters was 9.3 ؎ 3.0 months. During the follow-up period, the cumulative relapse rates at 1 year and 2 years posttreatment were 37.5% and 49.2%, respectively. Although interferon alfa (IFN-␣) has been accepted as an effective therapy in chronic hepatitis B (CHB), [1][2][3][4][5][6] it is known to be less effective in Asian patients because of the immune tolerance secondary to perinatal infection. [7][8][9] In addition, it has potential dose-limiting side effects and is inconvenient because of prolonged subcutaneous injection. 10 Lamivudine is an oral nucleoside analogue that inhibits reverse transcription by causing chain termination of nascent viral DNA in hepatitis B virus (HBV) infection. 11,12 Despite its effectiveness in suppressing HBV replication and safety, [13][14][15][16] the optimum duration of lamivudine therapy is not yet determined. From the experience of IFN-␣ 2,5,6 and lamivudine therapy in Western patients, 15,16 hepatitis B e antigen (HBeAg) seroconversion, defined as undetectable HBeAg/ HBV DNA and appearance of anti-HBe, can be regarded as an appropriate parameter for cessation of lamivudine.Although Dienstag et al. 15,16 reported that lamivudine-induced HBeAg seroconversion was durable and lamivudine could be stopped after HBeAg loss or seroconversion, the posttreatment follow-up duration in those studies ranged from only 4 to 12 months and the sample size was too small. To our knowledge, there is no long-term posttreatment follow-up study of patients who achieved lamivudine-induced HBeAg seroconversion. Furthermore, it is also unknown whether lamivudine-induced HBeAg seroconversion can be durable posttreatment in endemic areas such as Korea, where most HBV infection is considered to be transmitted vertically. 17,18 The aim of this study was to evaluate the posttreatment durability of lamivudine-induced HBeAg seroconversion in this endemic area and the predictive factors for relapse after cessation of lamivudine. PATIENTS AND METHODSPatients. We retrospectively analyzed 98 consecutive patients (77 men and 21 women; mean age, 34.9 Ϯ 9.4 years) with HBeAg-positive CHB who were treated with lamivudine between August 1996 and December 1997. Table 1 s...

Background and aims: Interferon (IFN) induced hepatitis B e antigen (HBeAg) seroconversion is durable in 80-90% of chronic hepatitis B patients. Preliminary reports on the durability of HBeAg seroconversion following lamivudine are contradictory. We investigated the durability of response following IFN, lamivudine, or IFN-lamivudine combination therapy in a meta-analysis of individual patient data. Patients and methods: Twenty four centres included 130 patients in total with an HBeAg seroconversion (HBeAg negative, antibodies to hepatitis B e antigen positive) at the end of antiviral therapy: 59 with lamivudine, 49 with interferon, and 22 with combination therapy. Relapse was defined as confirmed reappearance of HBeAg. Results: The three year cumulative HBeAg relapse rate by the Kaplan-Meier method was 54% for lamivudine, 32% for IFN, and 23% for combination therapy (p=0.01). Cox regression analysis identified pretreatment hepatitis B virus (HBV) DNA, alanine aminotransferase (ALT), sex, and therapy as independent predictive factors of post-treatment relapse; Asian race, previous therapy, centre, and type of study were not predictive of relapse. The relative HBeAg relapse risk of lamivudine compared with IFN therapy was 4.6 and that of combination therapy to IFN therapy 0.7 (p overall =0.01). Conclusions: The durability of HBeAg seroconversion following lamivudine treatment was significantly lower than that following IFN or IFN-lamivudine combination therapy. The risk of relapse after HBeAg seroconversion was also related to pretreatment levels of serum ALT and HBV DNA, but independent of Asian race.

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