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Int J Med Sci 2012; 9(1):27-32. doi:10.7150/ijms.9.27

Research Paper

Efficacy of Lamivudine or Entecavir on Acute Exacerbation of Chronic Hepatitis B

Tatsuo Kanda1*✉, Masami Shinozaki2*, Hidehiro Kamezaki1, Shuang Wu1, Shingo Nakamoto1, Makoto Arai1, Keiichi Fujiwara1, Nobuaki Goto2, Fumio Imazeki1, Osamu Yokosuka1

1. Department of Medicine and Clinical Oncology, Chiba University, Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
2. Department of Medicine, Numazu City Hospital, Numazu, Shizuoka 410-0302, Japan.
* These authors contributed equally to this article.


Background/Aims: Spontaneous acute exacerbation of chronic hepatitis B virus (HBV) infection occasionally occurs in its natural history, sometimes leading rapidly to fatal hepatic failure. We compared the effects of lamivudine (LAM) with those of entecavir (ETV) treatments in acute exacerbation of chronic hepatitis B with 500 IU/L or higher alanine aminotransferase (ALT) levels.

Methods: Thirty-four patients with acute exacerbation were consecutively treated with LAM /ETV. Their clinical improvements were compared.

Results: Among LAM-treated and ETV-treated patients, none showed a reduction of <1 log IU/mL in HBV DNA after 1 or 3 months of treatment. Initial virological response, defined as a reduction of 4 log IU/mL in HBV DNA at 6 months, with LAM and ETV, respectively, was 83.3% and 100%. One LAM patient developed hepatic encephalopathy, but all patients in both groups survived. Twelve months after treatment, 41.6% of 24 LAM group patients switched to another drug or added adefovir to their treatment due to the emergence of LAM-resistant mutants. On the other hand, patients receiving ETV did not need to change drugs.

Conclusions: ETV appears to be as effective as LAM in the treatment of patients with acute exacerbation of chronic hepatitis B. Clinicians should carefully start to treat these patients as soon as possible.

Keywords: acute exacerbation, ALT, entecavir, HBV, lamivudine

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) License. See for full terms and conditions.
How to cite this article:
Kanda T, Shinozaki M, Kamezaki H, Wu S, Nakamoto S, Arai M, Fujiwara K, Goto N, Imazeki F, Yokosuka O. Efficacy of Lamivudine or Entecavir on Acute Exacerbation of Chronic Hepatitis B. Int J Med Sci 2012; 9(1):27-32. doi:10.7150/ijms.9.27. Available from