Lamivudine monotherapy and lamivudine plus interferon alpha combination therapy in HBeAg negative chronic hepatitis B not responding to previous inter- feron alpha monotherapy

Background and study aims : To investigate the efficacy of the combined therapy of lamivudine (LAM) plus alpha interferon (IFN) and LAM monotherapy in HBeAg negative chronic hepati- tis B (CHB) patients who were unresponsive to previous IFN monotherapy, and the incidence of YMDD mutations. Patients-Methods: Forty-five HBeAg negative patients were enrolled in this study. 24 of these were treated with LAM (100 mg/day, PO. for 24 months) alone (group 1) and 21 with com- bined therapy (IFN-alpha-2b, 10 MU, tiw, SC, for 6 months plus LAM 100 mg/day, PO. for 24 months) (group 2). Normal alanine aminotransferase values and negativity of HBV DNA (molecular hybridization; Digene, USA) were accepted as treatment response. YMDD variants were analyzed at the end of treatment or when clinical breakthrough was observed (Inno-Lipa Innogenetic kit, Belgium). Results : End of follow-up response rate was 29.2%, by ITT in group 1, 19% in group 2 (p > 0.05). Histological activity index was statistically decreased by LAM monotherapy as compared to com- bination therapy. YMDD mutation rates were 59% in group 1, 62.5% in group 2 (p > 0.05). Conclusions : Additional IFN-alpha therapy to LAM in HBeAg negative CHB not responding to previous IFN-alpha monotherapy does not increase the response rate compared to LAM mono- therapy and does not also decrease the incidence of YMDD muta- tions. (Acta gastroenterol. belg., 2007, 70, 20-24).