Factors related to post treatment relapse in chronic hepatitis B patients who lost HBeAg after lamivudine therapy

Abstract

Background: It is uncertain that HBeAg loss after lamivudine therapy is durable. In Korean patients, the relapse rate is high after discontinuation of lamivudine therapy. Prolonged additional lamivudine therapy after HBeAg loss may be a proposal to reduce relapse rate.

Aims: We evaluated the factors and the patterns of relapse after lamivudine therapy.

Patients and Methods: 541 Korean chronic hepatitis B (CHB) patients with HBeAg positive were treated with lamivudine. Post-treatment monitoring continued.

Results: HBeAg loss occurred in 212 patients and lamivudine therapy was discontinued in 1.53 patients. Total 132 patients eligible to study were followed up after cessation of lamivudine therapy. 75 patients were relapsed (HBV DNA+ve and/or raised ALTs, cumulative relapse rate: 56% at 6 months). Relapse were occurred within 6 months in 68 of 75 patients. Sustained response, which had not relapsed over 6 months after discontinuing lamivudine therapy, was seen in only 32 patients. In multivariate analysis, the older age, higher total bilirubin, and shorter duration of additional lamivudine therapy were significant factors for relapse. Almost all patients with relapse had elevated ALT and reemergence of HBV DNA. HBeAg reappeared in 55 patients and twenty were HBeAg-ve relapse. There were 5 cases of breakthrough after HBeAg loss.

Conclusions: To reduce relapse after lamivudine therapy in CHB, age and serum bilirubin level of patients as well as duration of additional lamivudine therapy should be considered.