The combination of interferon-alpha 2b and Lamivudine in treatment of chronic hepatit B

Cengiz PATA, Duygu DÜŞMEZ, Aziz YAZAR, Kamuran KONCA, Ahmet ARHAN, Ali HAFTA, Candan ÖZTÜRK

Abstract

Objective: Although interferon are successfully used for the treatment of the chronic hepatitis B infections for many years, the obtained results are insufficent. Lamivudine, which is a nucleoside analouge, can block the viral replication up to 100% success, but can not act intracelluler viruses. The aim of this study was to investigate whether the combination treatment of interferon-$alpha$ 2b plus lamivudine is better than interferon-$alpha$ 2b alone or not. Method: For 20 patients, who had biochemical and histopathological diagnosis of chronic hepatitis B infection, lamivudine 100-150 mg/day plus interferon-$alpha$ 2b 10 million units as 3 times a week were given for a period of 6 months, for another 20 patients, who also have had biochemical and histopathological diagnosis of chronic hepatitis B infection, a 10 million units of interferon-$alpha$ 2b treatment as 3 times a week was given for a 6 months period. The subjects were assesed in 3, 6 and 12. months from begining of therapy on. Results: The seroconversion ofHBeAg were seen in 35.2% of patients who had recevied the combination therapy, whereas this ratio was 26.6% among monotherapy receving patients at the and of 12 months (p> 0.05). In the same groups the ALT levels have returned to normal with a 45% and 33-3% ratio (p> 0.05) (in 9 and 6 patients respectively). A negative HBV DNA meassurement was obtained in 18 (%90) at 6. month and 6 (%30) at 12. months of patients which received combination therapy, whereas this number was only 6 (30%) and 5 (%25) (p= 0.05, p< 0.05). Conclusion: The lamivudine therapy seems an effective drug for the HBV DNA normalization although there was no significant difference between two groups therapy.

Özet

Amaç: Kronik hepatit B tedavisinde interferon yıllardır kullanılmasına karşılık elde edilen sonuçlar yetersizdir. Lamivudin son yıllarda kullanıma giren viral replikasyonu %100'e yakın baskılayan bir nükleosit analoğudur. Bu çalışmada, interferon-$alpha$ 2b ile lamivudinin kombine kullanımının tek başına interferon-$alpha$ 2b kullanımına üstünlüğü olup olmadığının belirlenmesi amaçlandı. Yöntem: Biyokimyasal ve histopatolojik olarak kronik hepatit B tanısı alan 20 olguya 6 ay süreyle 100-150 mg/gün lamivudin ve haftada 3 gün 10 milyon ünite interferon-$alpha$ 2b, 20 olguya haftada 3 gün 10 milyon ünite interferon-$alpha$ 2b tedavisi verildi. Olgular tedavi başlangıcından itibaren 3, 6 ve 12. ayın sonunda değerlendirildi. Bulgular: Onikinci ayın sonunda kombine tedavi alan grupta HBeAg serokonversiyonu %35.2 iken interferon monoterapisi alan grupta %26.6 idi (p> 0.05). Yine bu gruplarda ALT normalleşmesi sırasıyla 9 (%45) ve 6 (%33.3) olguda gözlendi (p> 0.05). Kombine tedavi veya interferon tedavisi alan gruplarda 6. ayda HBV DNA negatifleşmesi 18 (%90) ve 6 (%30) (p< 0.05), 12. ayda ise 11 (%55) ve 5 (%25) olguda gözlendi (p= 0.05). Yorum: Kronik hepatit B tedavisinde lamivudin interferon kombine tedavisinin tek başına interferon kullanımına göre istatistiksel anlamlı üstünlüğü olmamasına rağmen, lamivudin HBV DNA negatifleşmesinde etkili bir ilaç olarak görülmektedir.