[Therapeutic efficacy of lamivudine in patients with hepatitis B virus-related decompensated cirrhosis in Korea].

Background/aims: Although several clinical trials have suggested that lamivudine treatment can be very effective in patients with decompensated HBV-associated cirrhosis, its role and clinical efficacy are still uncertain because of the study designs. The aim of this study is to evaluate the efficacy of lamivudine in consecutively enrolled patients with decompensated cirrhosis.

Methods: Twenty-four patients with decompensated HBV-associated cirrhosis (Child-Pugh score > or =8) were enrolled consecutively and treated with lamivudine 100 mg or 150 mg daily for 2-51 months (median: 16 months). They were all positive for HBV DNA and 21 were positive for serum HBeAg. Eight were Child-Pugh class B and 16 were class C. Clinical improvement was defined as a decrease of Child-Pugh score of at least 2 points.

Results: At 6(th) month after lamivudine, all the patients cleared serum HBV DNA. The cumulative rates for HBeAg loss were 28.6% at 6(th) and 46.6% at 12(th) month. The cumulative viral breakthrough rates at 12(th) and 24(th) month were 20.0% and 37.5%. Fourteen patients (60.8%) showed clinical improvement, while 8 (34.8%) showed no change and 1 got worse, at 6(th) month after lamivudine. Most clinical improvement developed within the initial 6 months. The cumulative mortality rates were 20.8% at 1 year and 37.5% at 2 year.

Conclusions: These data suggest that lamivudine can result in clinical improvement in about 60% of patients with HBV-related decompensated cirrhosis. Because most improvement occurs within 6 months after starting lamivudine, liver transplantation should be actively considered in cases which do not show clinical improvement despite 6-month lamivudine treatment.