Tenofovir Versus Lamivudine for Patients of Chronic Hepatitis B With Severe Acute Exacerbation
Status:
Unknown status
Trial end date:
2016-10-01
Target enrollment:
Participant gender:
Summary
In Taiwan, 15% of general population had hepatitis B virus (HBV) infection, HBV is the
leading cause of liver cirrhosis and hepatocellular carcinoma in Taiwan. After entering
immune clearance, 10-30% of patients of chronic HBV develop acute exacerbation (AE) , some
are mild but some developed hepatic decompensation or even death.
Previous study found that early use of lamivudine before bilirubin level is above 20 mg/dl
can improve survival in chornic HBV with severe AE. From the study from Hongkong, lamivudine
was found to have better survival than entecavir in chronic HBV with severe AE. Recent study
from India found that tenofovir is able to improve survival in chronic HBV with severe AE.
The aim of this study is to compare the effect of lamivudine and tenofovir for chronic HBV
with severe AE.
The study aims to enroll 120 patients with chronic HBV defined as persistence of HBsAg for
more than 6 months. Severe AE was defined as ALT > 400 U/L, prolongation of prothrombin time
> 3 seconds, bilirubin > 2 mg/dl. Patients with hepatitis A, C, D or HIV infection, drug or
alcoholic liver disease, hepatocellular carcinoma, under immuno-suppressive agents use, or
previous use of anti-HBV agents are excluded. All enrolled patients are randomized into group
A who received tenofovir 300 mg qd for 3 years and group B who received lamivuidne 100 mg qd
for 6 months, followed by tenofovir 300mg qd for 30 months. Mortality rate and virological,
biochemical and serological response were evaluated at 1,2,4,48,96 and 144 weeks. The values
are expressed as mean + SD. Categorical variables were analyzed with Chi-square test or
Fisher's exact test as appropriate and continuous variables were analyzed by Mann-Whitney
test. Logistic regression test was applied to analyze the independent association of various
variables with outcome. A p value < 0.05 was regarded as significant.