Safety and efficacy of lamivudine in patients with severe acute or fulminant hepatitis B, a multicenter experience

Acute hepatitis B progresses to liver failure withthe need of liver transplantation in about 1% of cases. Wetreated patients with severe acute or fulminant hepatitis Bwith lamivudine in an attempt to prevent hepatitis B virus(HBV) reinfection after potential liver transplantation. SinceSeptember 2000, 17 patients with severe acute or fulminantHBV infection were treated with 100 or 150 mg lamivudinedaily once we had evidence for a severe course as indicatedby an INR >2.0. These were compared to a historic controlfrom our unit and to external patients. Fourteen of the 17patients (82.4%) survived with full recovery without livertransplantation. All these 14 individuals cleared HBsAg onlamivudine within less than 6 months. Twelve patientsrecovered quickly as indicated by a normalized prothrombintime within 1 week while two patients had a more prolongedcourse. None of the patients showed an adverse event. Threepatients requiring transplantation despite lamivudine ther-apy had more advanced disease on admission, of whom onehad additionally ingested paracetamol (acetaminophen)while the second was already HBV-DNA negative by po-lymerase chain reaction on admission. The lamivudinetreated patients had significant higher frequency of survivalwithout liver transplantation 82.4 vs 20% (4/20) in thehistoric control (P < 0.001). Similar data were derived fromexternal centres using lamivudine (15/20, 75%). Lamivu-dine is safe in patients with severe acute or fulminanthepatitis B, leading to fast recovery with the potential toprevent liver failure and liver transplantation whenadministered early enough.Keywords: fulminant hepatitis, hepatitis B, lamivudine,severe acute hepatitis, therapy.