LAMIVUDINE VERSUS ENTECAVIR IN PATIENTS WITH HEPATITIS B VIRUS-RELATED DECOMPENSATED LIVER CIRRHOSIS

초록

Backgrounds/Purpose: Several studies have suggested that lamivudine (LMV) or entecavir (ETV) are effective in patients with hepatitis B virus (HBV)-related decompensated liver cirrhosis. However, it is still unclear whether the efficacies of LMV and ETV are different in those patients. This retrospective study was performed to compare the efficacy of LMV to that of ETV in patients with HBV-related decompensated liver cirrhosis. Methods: All patients with HBV-related decompensated cirrhosis who treated with LMV or ETV between January 2005 and December 2008 at Korea University Anam, Guro, or Ansan Hospitals were enrolled in this study. Patients with hepatocellular carcinoma (HCC) or those with previous history of antiviral therapy for HBV were excluded. All patients were classified into two groups according to the type of treatment: LMV group or ETV group. Decompensated liver cirrhosis was defined as ≥7 of Child score. Results: A total of 107 patients were enrolled in this study (mean age 53 years; 70.1% men). Baseline serum ALT and HBV DNA levels were 124±167 IU/L and 6.9±1.4log10 IU/mL, respectively. Hepatitis B e antigen (HBeAg) was positive in 45 patients (42.1%). Fifty-nine (55.1%) and 48(44.9%) patients were classified into Child group B and group C, respectively. Forty-nine (45.8%, LMV group) and 58 (54.2%,ETV group) patients were treated with LMV and ETV, respectively. Baseline characteristics, including serum ALT and HBV DNA levels, HBeAg status, Child score, and MELD score, did not differ between two groups. Serum HBV DNA levels at 3, 6,9, and 12 months after treatment were significantly lower in ETV group than in LMV group. Similarly, the prevalence of patients with undetectable HBV DNA (<12 IU/mL) was significantly higher in ETV group. However, serum ALT levels, Child and MELD score, and the prevalence of patients with Child group A at 3, 6, 9, and 12 months did not differ between two groups. The prevalence of HBeAg seroconversion and HCC and mortality did not differ between two groups, while that of viral breakthrough significantly more frequent in the LMV group than in ETV group. Conclusions: Both LMV and ETV were effective in patients with HBV-related decompensated liver cirrhosis. In addition, prognosis within one year of treatment did not differ between LMV and ETV groups. However, because the prevalence of viral breakthrough was more frequent in the LMV group, further studies are needed to compare the long-term prognosis of LMV and ETV groups.