Combination therapy with lamivudine and famciclovir for chronic hepatitis B infection

Hong Shen, Mazen Alsatie, George Eckert, Naga Chalasani, Lawrence Lumeng, Paul Y. Kwo

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Background & Aims: Lamivudine suppresses hepatitis B replication, but drug-resistant mutants emerge with long-term therapy. In vitro data suggest that lamivudine and famciclovir might synergistically inhibit hepadnaviral replication. We reviewed our experience with lamivudine and famciclovir in 24 patients with chronic hepatitis B infection. Methods: Patients with chronic hepatitis B infection and detectable HBV DNA received lamivudine and famciclovir combination therapy. The primary end point was HBV DNA suppression at week 48. Follow-up was reviewed for those who remained on combination therapy beyond the first 48 weeks. Results: Thirteen treatment-naïve HBeAg-positive subjects received 48 weeks of therapy; all had undetectable HBV DNA levels (less than 2.5 pg/mL) at week 48. Three patients underwent HBeAg seroconversion at week 48 and discontinued therapy. Ten patients remained on combination therapy; 3 developed YMDD (tyrosine-methionine-aspartate-aspartate) mutations at year 2, although HBV DNA levels remained below 2.5 pg/mL at a mean of 39 months. A second heterogeneous group of 5 subjects including interferon therapy failures and those with HBeAg-negative infection also received 48 weeks of combination therapy, with 1 subject developing redetection of HBV DNA by week 48. YMDD mutations were noted in the other 4 subjects at year 2, although just 1 subject had HBV DNA greater than 2.5 pg/mL at 39 months of therapy. Conclusions: In this small pilot study, 48 weeks of therapy with lamivudine and famciclovir was effective in suppressing HBV replication. A randomized controlled trial is required to define the role of combination therapy with lamivudine and famciclovir in delaying the clinical emergence of resistant strains.

Original languageEnglish (US)
Pages (from-to)330-336
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume2
Issue number4
DOIs
StatePublished - Apr 1 2004

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Keywords

  • HBeAb
  • HBIG
  • Hepatitis B e antibodies
  • Hepatitis B immune globulin
  • OLT
  • Orthotopic liver transplantation
  • PCR
  • Polymerase chain reaction

ASJC Scopus subject areas

  • Gastroenterology

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