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NDT Advance Access originally published online on December 22, 2005
Nephrology Dialysis Transplantation 2006 21(6):1740-1741; doi:10.1093/ndt/gfk001
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Letter

Long-term lamivudine therapy is not reasonable for HBV-associated nephropathy

Email: yyng{at}vghtpe.gov.tw

Sir,

With the article by Izzedine et al. [1] recently published in Nephrology Dialysis Transplantation, we feel the continued treatment with lamivudine for as long as possible after initial remission is not reasonable, because the proportion of patients with a documented lamivudine-resistant mutation increases from 23% in year 1 to 65% in year 5 [2,3]. Patients with lamivudine-resistant mutations experienced significantly more flare-ups of hepatitis than patients without (P<0.005) [2]. Although Tang et al. [4] described one patient who had a relapse of nephrosis after 2 years of complete remission when lamivudine was withdrawn, there no patient whose nephropathy was in complete or partial remission and who was being treated by an angiotensin-converting enzyme inhibitor at 12 months ended up with end-stage renal disease by 3 years of follow-up. It is supposed that the renal function is conserved when patient's proteinuria declines into remission levels. Therefore, long-term lamivudine therapy for the patients with HBV-associated nephropathy should be considered unnecessary, perhaps even unreasonable. Although the optimal duration of treatment and the criteria for stopping it have not been established, maintaining lamivudine therapy for 4–6 months following chemotherapy was suggested [5].

We would like to reinforce the point that long-term lamivudine therapy should be used only for patients who do not experience remission under supportive treatment, or for those with relapse of nephrosis after lamivudine withdrawal, so as to prevent lamivudine-resistant mutations and hepatitis flare-ups.

Conflict of interest statement. None declared.

Ming-Yu Lai1,2, Wu-Chang Yang1,2, Shon-Dong Lee1,2 and Yee-Yung Ng1,2

1 Department of Medicine Taipei Veterans General Hospital2 School of Medicine National Yang-Ming University Taipei Taiwan

References

  1. Izzedine H, Massard J, Poynard T, Deray G. Lamivudine and HBV-associated nephropathy. Nephrol Dial Transplant 2005; Advance access date 1st Nov 2005
  2. Chayama K, Suzuki Y, Kobayashi M et al. Emergence and takeover of YMDD motif mutant hepatitis B virus during long-term lamivudine therapy and re-takeover by wild type after cessation of therapy. Hepatology 1998; 27: 1711–1717[CrossRef][Web of Science][Medline]
  3. Lok AS, Lai CL, Leung N et al. Long term safety of lamivudine treatment in patients with chronic hepatitis B. Gastroenterology 2003; 125: 1714–1722[CrossRef][Web of Science][Medline]
  4. Tang S, Lai FMM, Lui YH et al. Lamivudine in hepatitis B-associated membranous nephropathy. Kidney Int 2005; 68: 1750–1758[CrossRef][Web of Science][Medline]
  5. Shibolet O, Ilan Y, Gillis S et al. Lamivudine therapy for prevention of immunosuppressive-induced hepatitis B virus reactivation in hepatitis B surface antigen carriers. Blood 2002; 100: 391–396[Abstract/Free Full Text]

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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
21/6/1740-a    most recent
gfk001v1
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Right arrow Articles by Lai, M.-Y.
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