High
Pre-treatment ALT Levels May Predict Earlier HBeAg Seroconversion in Chronic Hepatitis
B Patients Treated with Lamivudine (Epivir-HBV) By
Liz Highleyman
 A
pre-treatment serum alanine aminotransferase (ALT) level above 5 times the upper
limit of normal (ULN) is known to predict hepatitis B "e" antigen (HBeAg)
seroconversion during lamivudine (Epivir-HBV)
therapy for chronic hepatitis B, but it remains
unclear how even higher ALT or other viral factors affect treatment response,
according to the authors of a report published in the August 2008 issue of Liver
International.
To address this question, researchers from National
Taiwan University in Taipei analyzed retrospective data from 253 HBeAg positive
chronic hepatitis B patients who had a pre-treatment ALT level more than 5 times
ULN and who received lamivudine for 12-18 months. More than one-third (38%) had
received prior lamivudine treatment.
The primary study endpoint for response
was HBeAg seroconversion. Baseline clinical and viral features were compared between
responders and non-responders at the end of treatment and 6 months post-treatment.
Results
•
At the end of therapy, the overall HBeAg seroconversion rate was 33.6%.
•
For lamivudine-naive patients, the seroconversion rate was 37.8%.
•
Patients with pre-treatment ALT levels more than 10 times ULN had a significantly
higher HBeAg seroconversion rate than those with pre-treatment ALT between 5 and
10 times ULN, after both 3 months (P = 0.045) and 6 months (P=0.037) of lamivudine
treatment.
•
No significant differences in pre-treatment serum ALT values, HBV viral load,
or HBV genotypes were found between seroconverters and non-seroconverters at the
end of treatment or post-treatment.
Based
on these findings, the study authors concluded, "For lamivudine-treated HBeAg
positive patients with pre-therapy ALT levels over 5 times ULN, an even higher
ALT level could predict earlier HBeAg seroconversion." However, they added,
"neither ALT levels nor viral factors correlate with higher response rates
after 12-18 months of treatment."
9/16/08 Reference
TC
Tseng, CJ Liu, CC Wang, and others. A higher alanine aminotransferase level correlates
with earlier hepatitis B e antigen seroconversion in lamivudine-treated chronic
hepatitis B patients. Liver International 2897): 1034-1041. August 2008.
(Abstract).
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