Short‐term corticosteroids then lamivudine and plasma exchanges to treat hepatitis B virus–related polyarteritis nodosa

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Abstract
Objective To assess the efficacy and safety of lamivudine, an antiviral agent that strongly inhibits hepatitis B virus (HBV) DNA replication, combined with plasma exchanges after short‐term corticosteroids for HBV‐related polyartertitis nodosa (PAN). Methods Ten patients (8 men, 2 women, mean ± SD age 50.4 ± 14.4 years) with previously untreated HBV‐related PAN were included in a multicenter, prospective, observational trial. Oral prednisone (1 mg/kg/day) was given for 1 week, then tapered and withdrawn within 1 week. Then, lamivudine (100 mg/day or less in the case of renal insufficiency) was started for a maximum of 6 months. Plasma exchanges were performed simultaneously and scheduled as follows: 3/week for 3 weeks, 2/week for 2 weeks, then 1/week until hepatitis B e antigen (HBeAg) to anti‐HBe antibody (HBeAb) seroconversion was obtained or until 2–3 months of clinical recovery was sustained. The primary trial endpoint was clinical recovery from HBV‐PAN at 6 months. The secondary endpoint was loss of detectable serum HBeAg and HBV DNA, and HBeAg to HBeAb seroconversion at 9 months. Results One death, attributed to catheter‐related septicemia, was recorded. At 6 months, all 9 survivors had achieved clinical recovery and by 9 months, 6 of 9 (66%) had seroconverted. Conclusion The strategy of short‐term steroids followed by lamivudine and plasma exchanges effectively led to recovery from HBV‐PAN. Because of its oral administration and good safety profile, lamivudine should henceforth be considered the antiviral agent of choice to treat HBV‐related PAN.