Sustained response after a 2‐year course of lamivudine treatment of hepatitis B e antigen‐negative chronic hepatitis B

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Abstract
Summary. Lamivudine has demonstrated efficacy for the treatment of hepatitis B e antigen‐negative chronic hepatitis B (e‐CHB). However, treatment withdrawal after 1 year has been associated with a high rate of relapse while long‐term treatment is associated with increasing risks of drug resistance. We report our treatment experience of 50 Chinese‐Canadian patients with e‐CHB. All patients received lamivudine for 2 years. Treatment was withdrawn at month 24 in patients who had undetectable hepatitis B virus (HBV) DNA by PCR and normal aminotransferases during the second year of therapy. All patients had HBV genotype B or C. Biochemical response at months 6, 12 and 24 was 74%, 71% and 66%, respectively. HBV DNA was undetectable at months 6, 12 and 24 by hybrid capture and PCR assays in 100%, 92% and 86%; and 94%, 88% and 74% patients, respectively. The cumulative rates of genotypic resistance (GR) after 1 and 2 years were 15% and 25%, respectively. Four (44%) patients with GR experienced a hepatitis flare. The probability of clinical and virological relapse 6, 12, and 18 months after treatment withdrawal were 12% and 30%, 18% and 50%, and 30% and 50%, respectively. Reinstitution of lamivudine resulted in prompt virological and biochemical responses. Our study demonstrates that a sustained response can be achieved after a 2‐year course of lamivudine in a subset of patients with e‐CHB.