Extended lamivudine treatment in patients with chronic hepatitis B enhances hepatitis B e antigen seroconversion rates: Results after 3 years of therapy

A study in Chinese patients with chronic hepatitis B showed that treatment with lamivudine for 1 year significantly improves liver histology and enhan ces hepatitis B e antigen (HBeAg) seroconversion compared with placebo. Fif ty-eight patients from this 1-year study have received long-term treatment with lamivudine 100 mg; the outcome of 3 years of lamivudine is reported he re. Before treatment, all patients bad detectable HBeAg. HBeAg seroconversi on (HBeAg-negative, anti-HBe-positive), hepatitis B virus (HBV)-DNA suppres sion, alanine transaminase (ALT) normalization, emergence of YMDD variant H BV, liver histology, and long-term safety were assessed. After 3 years of c ontinuous treatment with lamivudine 100 mg daily, 40% (23 of 58) of patient s achieved HBeAg seroconversion, In patients with baseline serum ALT >2x up per limit of normal (ULN), the rare of HBeAg seroconversion was 65% (17 of 26), Median serum HBV-DNA concentrations were below the level of detection, and median ALT concentrations were within the normal range throughout 3 ye ars of treatment. YMDD variant HBV emerged in 33 of 58 (57%) patients durin g the 3 years, of whom 9 (27%) achieved HBeAg sero conversion (6 after emer gence of YMDD variant HBV). ALT levels and histologic scores after emergenc e of YMDD variant HBV did not show major deterioration. Lamivudine was well tolerated during 3 years of therapy. In conclusion, these data in Chinese patients with chronic hepatitis B show enhanced seroconversion rates with e xtended lamivudine treatment. Up to two thirds of patients with moderately elevated pretreatment ALT achieved HBeAg seroconversion after 3 years of th erapy.