The Side Effects Of Monotherapy With Lamivudine

Main Category: Infectious Diseases / Bacteria / Viruses
Also Included In: GastroIntestinal / Gastroenterology;  Clinical Trials / Drug Trials
Article Date: 24 Sep 2008 - 10:00 PDT

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Lamivudine has a high rate of antiviral resistance. Sequential anti-HBV treatment is commonly used for lamivudine resistance. We report 4 cases with rapid re-detection of HBV mutants during the lamivudine re-treatment.

The article was published in the World Journal of Gastroenterology. In this report, four patients received lamivudine as an initial treatment of HBV. They had adefovir and lamivudine as a rescue therapy consecutively. HBV-DNA level, YMDD mutations and adefovir -resistant mutations (RFMP) were tested every 3 mo during the sequential treatment. All the patients showed YMDD mutations during the initial lamivudine therapy. After adefovir therapy for lamivudine resistance, they showed viral breakthrough. Adefovir was switched to lamivudine, however, it did not induce viral suppression at all, rather increased in HBV-DNA with rapid re-emergence of the YMDD mutations. All the patients had ALT flares, and hepatic decompensation occurred in two patients. After switching to adefovir combined with entecavir or lamivudine for a rescue therapy, the patients had reduction in HBV-DNA and ALT improvement. These cases demonstrated that lamivudine re-treatment in patients with pre-exposed lamivudine resistance leads to rapid re-emergence of YMDD mutation with significant viral rebound and subsequent hepatic decompensation. Sequential administration of lamivudine with prior history of YMDD mutation should be abandoned.

The result suggests that lamivudine re-treatment in patients with pre-exposed lamivudine resistance leads to rapid re-emergence of YMDD mutation with significant viral rebound and subsequent hepatic decompensation. Sequential administration of lamivudine with prior history of YMDD mutation should be abandoned.

The study highlights that retreatment with lamivudine in patients with severe liver disease should be avoided.

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Article adapted by Medical News Today from original press release.
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Reference: Kwon SY, Choe WH, Lee CH, Yeon JE, Byun KS. Rapid re-emergence of YMDD mutation of HBV with hepatic decompensation after lamivudine re-treatment. World J Gastroenterol 2008; 14(27): 4416-4419 http://www.wjgnet.com/1007-9327/14/4416.asp

Correspondence to: So Young Kwon, MD, Department of Internal Medicine, Konkuk University Hospital, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea.

About World Journal of Gastroenterology

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection. It provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th of every month. The WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the title China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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The WJG Press mainly publishes World Journal of Gastroenterology.

Source: Lai-Fu Li
World Journal of Gastroenterology