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High Dose Lamivudine in HBV-Related Cirrhotic Patients with Unsatisfactory Response After Adefovir Add-On

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An Erratum to this article was published on 24 February 2012

Abstract

Background

Before tenofovir approval for chronic hepatitis B therapy, the clinical management of patients with suboptimal response or virological breakthrough during combination treatment with lamivudine and adefovir dipivoxil was a difficult clinical challenge.

Aims

In order to improve virologic response and reduce the risk of decompensation, we evaluate the efficacy of a high dose of lamivudine on chronic HBV patients who have previously presented an unsatisfactory response during treatment with lamivudine 100mg/day and adefovir 10mg/day.

Methods

Six patients with HBV-related liver cirrhosis were prospectively enrolled. All were HBeAg-negative and presented a suboptimal response or virological breakthrough after "adefovir add-on" because of development of clinical breakthrough during Lamivudine treatment. Lamivudine dose was increased to 200 or 300mg, depending on viral load. After 12 months of follow-up, virological and biochemical response were evaluated.

Results

After 12 months of high-dose lamivudine, all patients (6/6, 100%) achieved a significant decrease of serum HBV DNA (mean reduction 2,62 ± 1,15 Log10 UI/ml, P = 0.03) and normalized ALT. In three patients (3/6, 50%), HBV DNA became undetectable within 6 months. No patient developed liver decompensation and no significant changes occurred in serum creatinine, serum and urinary electrolytes. No adverse events were registered.

Conclusions

In our experience, rescue strategy with high-dose lamivudine inhibited viral replication leading to undetectability of serum HBVDNA. This rescue treatment presented a good safety profile, without adverse events during the study period. Customized increase of nucleos(t)ide analogues dose in difficult-to-treat patients may be a proficient approach in challenging clinical setting.

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Abbreviations

ADV:

Adefovir dipivoxil

CHB:

Chronic HBV hepatitis

HBeAg:

HBV e antigen

HBV:

Hepatitis B virus

LAM:

Lamivudine

NUC:

Nucleot(s)ide

TDF:

Tenofovir disoproxil fumarate

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Conflict of interest

The authors received no funding for writing this paper, and they declare no conflict of interest.

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Authors and Affiliations

  1. Department of Clinical Medicine, Gastroenterology Unit, St. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy

    Marco Montagnani, Marina Giandinoto, Andrea Lisotti, Francesco Azzaroli, Federica Buonfiglioli, Laura Turco & Giuseppe Mazzella

  2. Department of Microbiology, Hematology e Laboratory Medicine, St. Orsola-Malpighi Hospital, Bologna, Italy

    Silvia Galli

  3. SMETEC Department, University of Bologna, Bologna, Italy

    Rita Aldini

Authors
  1. Marco Montagnani
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  2. Marina Giandinoto
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  6. Federica Buonfiglioli
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  9. Giuseppe Mazzella
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Corresponding author

Correspondence to Giuseppe Mazzella.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s10620-012-2091-x.

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Montagnani, M., Giandinoto, M., Lisotti, A. et al. High Dose Lamivudine in HBV-Related Cirrhotic Patients with Unsatisfactory Response After Adefovir Add-On. Dig Dis Sci 57, 561–567 (2012). https://doi.org/10.1007/s10620-011-1873-x

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  • DOI: https://doi.org/10.1007/s10620-011-1873-x

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