Document Detail


Sequential treatment with lamivudine and alpha-interferon in anti-HBe-positive chronic hepatitis B patients: a pilot study.
MedLine Citation:
PMID:  17652045     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In chronic hepatitis B, long-term use of alpha interferon is hampered by side effects, and long-term treatment with nucleos(t)ide analogues is burdened by drug-resistant mutants. We hypothesized that alternate rounds of lamivudine and alpha interferon might circumvent previous shortcomings. AIM: To evaluate efficacy of sequential lamivudine or IFN-alpha2b monotherapies in preventing occurrence of tyrosine-methionine-aspartate-aspartate (YMDD) mutants and achieving virological and biochemical response. METHODS: Fifteen patients with hepatitis B surface antigen, anti-HBe-positive chronic hepatitis received four consecutive rounds of monotherapy with lamivudine (100 mg/day), IFN-alpha2b (5MU/tiw), lamivudine, IFN-alpha2b. Serum HBV-DNA levels were evaluated during and off treatment, HBV polymerase and pre-core/core regions sequenced. RESULTS: End-of-treatment response was achieved in 10 patients (67%). One patient did not respond, a second developed genotypic resistance at week 24. A rebound in viremia occurred in three patients at week 48. Six patients (40%) remained sustained responders. Triple promoter mutations at nucleotides 1762-1764-1896 prevailed in non-responders (60%) as compared to responders (20%). L180M/M204V mutations were identified during virological breakthrough. CONCLUSION: Sequential approach of alternate rounds of lamivudine or interferon may help patients to tolerate a prolonged schedule of therapy and protect them from emergence of viral strains.
Authors:
G A Niro; R Fontana; D Gioffreda; S Fiorella; L Accadia; A Iacobellis; N Caruso; P Conoscitore; A Andriulli
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Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2007-07-25
Journal Detail:
Title:  Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver     Volume:  39     ISSN:  1590-8658     ISO Abbreviation:  Dig Liver Dis     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-08-16     Completed Date:  2007-11-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100958385     Medline TA:  Dig Liver Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  857-63     Citation Subset:  IM    
Affiliation:
Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy. g.niro@operapadrepio.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Antiviral Agents / administration & dosage*
DNA, Viral / drug effects
Drug Administration Schedule
Drug Resistance, Multiple, Viral / genetics
Female
Hepatitis B virus / drug effects*,  genetics
Hepatitis B, Chronic / drug therapy*
Humans
Interferon Alfa-2b / administration & dosage*
Lamivudine / administration & dosage*
Male
Middle Aged
Pilot Projects
Viral Load
Chemical
Reg. No./Substance:
0/Antiviral Agents; 0/DNA, Viral; 134678-17-4/Lamivudine; 99210-65-8/Interferon Alfa-2b

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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