Efficacy and safety of lamivudine treatment for chronic hepatitis B in pregnancy

AIM:To evaluate the efficacy and safety of lamivudinetreatment of chronic hepatitis B disease in pregnancy.METHODS:The study group was comprised of 38 chronicHBV patients who were diagnosed pregnant duringIamivudine treatment and voluntary to continue the sametherapy.The control group was from documented patientdata in the literatures.We compared the followingparameters with those of a control group:anti-HBV efficacy,complications of pregnancy (abortion,preterm birth,neonatalasphyxia,fetal death,and congenital anomaly),incidenceof HBV-positive babies and developmental anomalies inpregnant women treated with Iamivudine.RESULTS:The blocking rate of lamivudine treatment wassignificantly higher than that of active vaccine immunizationfor babies with double-positive (HBsAg/HBeAg) mothers with30-30-10 μg doses of vaccine (74.07%) and with 30-20-10 μg(64.87%).The natural vertical HBV transmission from motherto infant of “double-positive”mothers was 100% (10/10).No pregnancy complication was noted during the observationperiod,but in the control group the incidences of pregnancycomplication were 16.67% (abortion),43.02%(preterm),15.62% (neonatal asphyxia),and 4.49% (fetal death),10.0% (congenital anomaly).No HBV-positive newborn wasdetected and no developmental anomaly was found in thestudy group.CONCLUSION:Lamivudine is helpful to prevent maternal-infant HBV transmission and may reduce the complicationsof HBV-infected pregnant patients.     

Is telbivudine superior to lamivudine for the treatment of patients with chronic hepatitis B?

This practice point commentary discusses the findings and limitations of a prospective, double-blind, phase III trial conducted by Lai et al. in which patients with chronic hepatitis B (CHB) were randomly allocated to receive telbivudine 600 mg daily or lamivudine 100 mg daily. The trial showed that telbivudine was superior to lamivudine in terms of mean reduction in number of HBV DNA copies/ml from baseline, the number of patients with a reduction in serum HBV DNA to undetectable levels, and rate of HBV drug resistance. This commentary highlights the issues to consider when interpreting and generalizing these results, including the fact that lamivudine is no longer recommended as first-line therapy for patients with CHB and that head-to-head comparisons between telbivudine and its two alternatives-entecavir and adefovir dipivoxil-have not been performed. The importance of selecting patients for treatment according to predictive factors of a good response is also highlighted.     

Successful tocilizumab treatment in a patient with adult-onset Still’s disease complicated by chronic active hepatitis B and amyloid A amyloidosis

We report successful tocilizumab (TCZ) use in a patient with adult-onset Still’s disease (AOSD) complicated by chronic hepatitis B (CHB) and AA amyloidosis (AAA). Treatments with corticosteroid and various types of immunosuppressants were unsuccessful. Aggravation of CHB ensued, and entecavir was started. Normalisation of liver function and hepatitis B virus (HBV) DNA were confirmed. TCZ was then started. His arthritis and AAA improved dramatically. TCZ is an excellent treatment for refractory AOSD and is feasible in an HBV-infected patient.     

Predictive value of different hepatitis C serological assays in the treatment of chronic hepatitis C with interferon α

In order to predict the complete response rate of natural interferon-α (nIFN-α) treatment in patients with chronic active hepatitis C, we examined the predictive value (PV) of different hepatitis C serological assays. We performed first generation (ver.1) and second generation (ver.2) hepatitis C virus (HCV) branched DNA-probe assays (bDNA-probe), HCV core protein assay (core protein), HCV Amplicor Monitor assay (amplicor monitor), and HCV competitive polymerase chain reaction (competitive PCR) assay, using serum samples collected immediately before initiation of treatment. For each marker, we studied, in patients stratified by serological group (Gr), which predictive value (PV) of the HCV titers showed association with the therapeutic effect. In 59 Gr 1 patients, complete response to nIFN-α treatment was predicted from the following PVs for each marker: 0.5 Meq/ml or less (odds ratio 11.7; P = 0.0010) with ver.1, 1.0 Meq/ml or less (odds ratio 5.3; P = 0.0119) with ver.2 of the bDNA-probe, 50 pg/ml or less (odds ratio 10.3; P = 0.0062) with core protein, 200 × 10³ copy/ml or less (odds ratio 7.8; P = 0.0031) with amplicor monitor, and 10⁴ copy/ml or less (odds ratio 6.2; p = 0.8395) with competitive PCR. In 27 Gr 2 patients, the PV for each marker indicating complete response was as follows: There was no relationship between PV and therapeutic effect with ver.1 of the bDNA-probe, while the PVs for the other markers were 0.2 Meq/ml or less (odds ratio 2.2; P = 0.3788) with ver.2, 20 pg/ml or less (odds ratio 5.6; P = 0.0597) with core protein, 400 × 10³ copy/ml or less (odds ratio 4.0; P = 0.2965) with amplicor monitor, and 10^5.5 copy/ml or less (odds ratio 29.2; P = 0.0096) with competitive PCR. Our findings showed that complete response to the treatment may be predicted using the appropriate PV for each marker. (Received Apr. 13, 1998; accepted Aug. 28, 1998)     

Will a second biopsy sample affect treatment decisions in patients with chronic hepatitis B?

Background and aim

Liver biopsy is the gold standard for assessment of fibrosis in patients with hepatitis B. However, it has some disadvantages, including inter-observer and intra-observer variability in biopsy interpretation and specimen variation. A standard biopsy specimen represents only about 0.0002 % of the whole liver. It has been shown that two biopsy samples collected during a procedure have significant influence on the diagnostic performance of interpretation in patients with hepatitis C or non-alcoholic steatohepatitis. Therefore, we aimed to assess the influence of collecting two liver biopsy samples during a single procedure for staging and grading chronic hepatitis B.

Patients and methods

27 patients were included in the study. The median age of the patients was 43.51 ± 11.69. Fifteen patients were female, 12 patients were male. In the biopsy procedure, two samples of liver lobes were obtained. Grade and stage scores were compared between the two samples. Fibrosis staging and grading were assessed according to the Ishak scoring system.

Results

Numbers of portal tract and biopsy size were equal in the two samples. There was a significant difference between the samples in terms of histological activity index (p value = 0.04). However, the difference was not enough to distinguish the mild and moderate stages. On the other hand, no significant difference in fibrosis staging between the two samples was found.

Conclusions

With this relatively small size of patients, in this study, we showed that a proper liver biopsy size is sufficient to predict treatment decisions in chronic hepatitis B patients. However, further studies are needed to show the association of sampling variability in patients with hepatitis B.

     

Effect of Qinling granule in treatment of 102 patients with chronic hepatitis B

ＥｆｅｃｔｏｆＱｉｎｌｉｎｇｇｒａｎｕｌｅｉｎｔｒｅａｔｍｅｎｔｏｆ１０２ｐａｔｉｅｎｔｓｗｉｔｈｃｈｒｏｎｉｃｈｅｐａｔｉｔｉｓＢＨＵＡＮＧＺｈｅｎｇＭｉｎｇ１，ＹＡＮＧＸｉｎＢｏ１，ＣＡＯＷｅｎＢｉｎ１，ＺＨＯＵＹｉＪｕｎ２ａｎｄＬＵＬｉ...     

Current treatment for chronic hepatitis?B in Japan

To standardize diagnosis, treatment, and management of chronic hepatitis B, updated treatment guidelines in Japan have been formulated by a research team of the Japanese Ministry of Health, Labor and Welfare (MHLW)’s study project “Research on standardization of treatment for viral liver diseases including liver cirrhosis.” The guidelines recommend first that chronic hepatitis B patients characterized by ALT levels of at least 31 IU/l, with HBe antigen (HBeAg)-positive patients having HBV DNA levels of at least 5 log copies/ml and HBeAg-negative patients with HBV DNA levels of at least 4 log copies/ml, be targeted for treatment. Patients indicated for treatment intervention, for whom are suggested such basic treatments as entecavir therapy, long-term interferon (IFN) therapy, and sequential therapy, are divided into age groups comprising young patients (less than 35 years of age) and middle-aged/elderly patients (35 years and older), HBeAg-positive and HBe-negative patients, and patients with HBV DNA levels of at least 7 log copies/ml and those of less than 7 log copies/ml. As for switching to entecavir for chronic hepatitis B patients currently undergoing lamivudine therapy, the guidelines suggest specific therapies for different groups, dividing patients into those undergoing lamivudine therapy for less than 3 years and those treated for 3 years or longer, as well as those having HBV DNA levels of less than 1.8 log copies/ml and those of 1.8 log copies/ml or more. Formulated on the basis of consideration of chronic hepatitis B patient age, ALT level, HBeAg status, HBV DNA level, and liver disease severity, these guidelines are considered useful for the understanding and implementation of chronic hepatitis B infection diagnosis and treatment, which in recent years have advanced markedly and grown ever more diverse.     

Does ascorbic acid prevent retinopathy during interferon therapy in patients with chronic hepatitis C?

Purpose. Ascorbic acid was administered to patients with chronic hepatitis C to elucidate the mechanism of onset of retinopathy during interferon (IFN) therapy, and its prevention. Methods. The subjects were 62 patients with chronic hepatitis C who had been admitted to our hospital. For the IFN therapy, 6 MIU of natural IFN-α or 10 MIU of recombinant human IFN-α 2b was administered every day for the first 2 weeks, followed by administration three times a week for 22 weeks. The patients were randomly assigned to a group receiving 600 mg/day of ascorbic acid or a group not receiving ascorbic acid (control group). The optic fundi were examined by ophthalmologists before the IFN therapy began and subsequently at weeks 2 and 4 and then every 4 weeks during the IFN therapy. Results. Retinopathy was found in 9 of the 31 patients (29%) in the ascorbic acid-treated group and in 11 of the 31 patients (35%) in the control group. The cumulative incidence of hemorrhage in the ascorbic acid-treated group was lower than that in the control group during the IFN therapy, but the difference between the two groups was not significant (P = 0.186). The cumulative incidence of cotton-wool spots in the ascorbic acid-treated group was almost same as that in the control group during the IFN therapy. The median platelet counts before the therapy was begun were 11.8 × 10⁴/mm² in the group with hemorrhage and 16.6 × 10⁴/mm² in the group without, and the lowest platelet counts during IFN therapy were 7.3 × 10⁴/mm³ in the group with hemorrhage and 9.5 × 10⁴/mm³ in the group without, indicating significantly lower values in the group with hemorrhage (P = 0.018 and P = 0.020, respectively). The lowest platelet counts during IFN therapy were 7.4 × 10⁴/mm³ in the group with cotton-wool spots and 9.7 × 10⁴/mm³ in the group without, indicating a significantly lower value in the group with cotton-wool spots (P = 0.036). Conclusions. Ascorbic acid was not considered to be useful for the prevention of the retinopathy associated with IFN therapy in patients with chronic hepatitis C. Received: September 14, 2000 / Accepted: January 19, 2001     

Reactivation of hepatitis B in a patient with Crohn’s disease treated using infliximab

We encountered a case of reactivation of hepatitis B virus after administration of infliximab for Crohn's disease. The use of infliximab was considered because the patient displayed abdominal symptoms and perianal lesions. Transaminases were normal, and hepatitis B virus (HBV) DNA was undetectable before treatment, so no antiviral treatment was used, and infliximab and low-dose 6-mercaptopurine were administered. This treatment was effective, but liver dysfunction and reactivation of HBV were observed after the fourth injection of infliximab. This is the first report of Crohn's disease for which infliximab use was continued even after reactivation of HBV was observed. However, liver dysfunction was not improved by lamivudine. Antiviral treatment should be considered before administration of infliximab for patients with HBV.     

Successful treatment of a patient with primary Sjögren's syndrome complicated with pericarditis during pregnancy

A 35-year-old woman with primary Sj?gren's syndrome (pSS) developed fever and chest pain during pregnancy. When the dose of prednisolone was reduced, she experienced chest pain with elevated CRP and D-dimer, resulting in admission to our hospital with marked cardiomegaly and pleural effusion. Because there was no evidence of other autoimmune disorders or infection, oral prednisolone was increased to 30 mg daily with heparin, and hypercoagulopathy was carefully monitored. The patient's condition improved rapidly, and she delivered a healthy baby. This is the first case to support the beneficial effect of prednisolone in pericarditis with pSS, and illustrates its safety during pregnancy.