P1490 Lamivudin treatment in patients with acute severe hepatitis B

Rožnovský, Luděk; Orságová, Irena; Kloudová, Alena; Mrázek, Jakub; Lochman, I

doi:10.1016/s0924-8579(07)71329-8

Cited by 6 publications

(14 citation statements)

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“…Similar to our data , very good survival rates (mean survival rate almost 80%) in patients receiving lamivudine have been reported by others , whereas outcome without antiviral therapy has remained poor (see also Table ).…”

Section: Antivirals In the Setting Of Severe Acute To Fulminant Hepatsupporting

confidence: 92%

Management of severe acute to fulminant hepatitis B: to treat or not to treat or when to treat?

Tillmann

Zachou

Dalekos

2011

Liver International

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Despite a decline in cases of acute hepatitis B and the low hepatitis B virus (HBV) chronicity rates in adults, still some patients progress to HBV‐related fulminant liver failure. In this review, we discuss treatment options that may prevent the progression of severe acute hepatitis B to fulminant liver failure and death. In severe acute HBV with prolonged prothrombin time and increased bilirubin, interferon failed to be effective while antiviral treatment, particularly with lamivudine, appears to improve survival (mean survival almost 80%). Outcome without antiviral therapy has remained considerably poor, whereas there is no convincing evidence of amelioration of HBV‐targeted immunity. Of note, most patients who died or required transplantation despite lamivudine therapy, were started on lamivudine at advanced stages compared with those survived. This suggests that prompt and timely antiviral therapy is crucial. Owing to the abovementioned results the design of randomized placebo‐control trials in the setting of severe acute hepatitis B seems unethical. On the contrary, the design of multicentre double‐blind randomized trials to compare the efficacy between lamivudine and entecavir or even tenofovir in acute severe HBV cases is ideally needed, but these studies appear to be very difficult to perform considering that these cases are not frequent and therefore, it is almost impossible to have two arms adequately numerous and homogenous for statistical evaluation. Thus, in the absence of solid evidence based data, the hepatologists could treat their patients with severe acute hepatitis B with lamivudine or the most potent antivirals entecavir or tenofovir.

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Section: Antivirals In the Setting Of Severe Acute To Fulminant Hepatsupporting

confidence: 92%

Management of severe acute to fulminant hepatitis B: to treat or not to treat or when to treat?

Tillmann

Zachou

Dalekos

2011

Liver International

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“…Antiviral treatment for fulminant hepatitis B is recommended in order to reduce the risk of death and the need of emergency liver transplantation. Support for such a strategy may be found in a small number of reports with lamivudine but the efficacy is unproven (7, 8, 11, 12). There are ethical problems related to conducting a randomized, double‐blind, placebo‐controlled trial in such a serious disease condition.…”

Section: Discussionmentioning

confidence: 99%

Lamivudine treatment is associated with improved survival in fulminant hepatitis B

Sun

Yan

et al. 2011

Liver International

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“…The experience with lamivudine treatment of patients with severe acute hepatitis B is limited and controversial. There are ethical problems to conducting a randomized, doubleblind, placebo-controlled trial in such a serious disease condition, because the previous encouraging results of lamivudine have been reported [4][5][6]. However, the possibility that severe acute hepatitis B might naturally subside without treatment cannot be completely excluded, and whether lamivudine efficiently prevents the rapid progression to hepatic failure could not be confirmed.…”

Section: Discussionmentioning

confidence: 99%

“…Lamivudine, an L-nucleoside analogue, at a daily dose of 100 mg, is effective in suppressing HBV DNA with alanine aminotransferase (ALT) normalization and histological improvement in both hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients [3]. However, with regard to lamivudine treatment of patients with severe acute hepatitis B, studies with a limited number of patients and case reports are encouraging [4][5][6]. Tillmann et al reported that lamivudine may prevent the progression of severe hepatitis B to liver failure by decreasing HBV DNA load, reducing inflammatory reaction and improving liver function when administered early enough [7].…”

Section: Introductionmentioning

confidence: 99%