Clinical Trial of Lamivudine in Children with Chronic Hepatitis B
Maureen M. Jonas, M.D., Deirdre A. Kelley, M.D., Jacek Mizerski, M.D., Isabel B. Badia, M.D., Jorge A. Areias, M.D., Kathleen B. Schwarz, M.D., Nancy R. Little, B.S., Martin J. Greensmith, Ph.D., Stephen D. Gardner, M.S.P.H., M. Steve Bell, B.Sc., Etienne M. Sokal, M.D., for the International Pediatric Lamivudine Investigator Group
Background Lamivudine therapy is effective for chronic hepatitisB infection in adults. We evaluated the efficacy and tolerabilityof lamivudine as a treatment for chronic infection with hepatitisB virus (HBV) in children.
Methods Children with chronic hepatitis B were randomly assignedin a 2:1 ratio to receive either oral lamivudine (3 mg per kilogramof body weight; maximum, 100 mg) or placebo once daily for 52weeks. The primary end point was virologic response (definedby the absence of serum hepatitis B e antigen and serum HBVDNA) at week 52 of treatment.
Results Of the 403 children screened, 191 were randomly assignedto receive lamivudine and 97 to receive placebo. The rate ofvirologic response at week 52 was higher among children whoreceived lamivudine than among those who received placebo (23percent vs. 13 percent, P=0.04). Lamivudine therapy was welltolerated and was also associated with higher rates of seroconversionfrom hepatitis B e antigen to hepatitis B e antibody, normalizationof alanine aminotransferase levels, and suppression of HBV DNA.
Conclusions In children with chronic hepatitis B, 52 weeks oftreatment with lamivudine was associated with a significantlyhigher rate of virologic response than was placebo.
Source Information
From Children's Hospital, Boston (M.M.J.); Diana Princess of Wales Hospital, Birmingham, United Kingdom (D.A.K.); John Paul II Hospital, Krakow, Poland (J.M.); Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina (I.B.B.); Hospital Geral de Santo Antonio, Porto, Portugal (J.A.A.); Johns Hopkins University, Baltimore (K.B.S.); GlaxoSmithKline, Research Triangle Park, N.C. (N.R.L., S.D.G., M.S.B.); GlaxoSmithKline, Greenford, United Kingdom (M.J.G.); and Cliniques Universitaires St. Luc, Brussels, Belgium (E.M.S.).
Address reprint requests to Dr. Jonas at the Division of Gastroenterology, Children's Hospital, 300 Longwood Ave., Boston, MA 02115.
Guido, M., Bortolotti, F.
(2008). Chronic viral hepatitis in children: any role for the pathologist?. Gut
57: 873-877
[Full Text]
Sokal, E. M., Kelly, D., Wirth, S., Mizerski, J., Dhawan, A., Frederick, D.
(2008). The Pharmacokinetics and Safety of Adefovir Dipivoxil in Children and Adolescents With Chronic Hepatitis B Virus Infection. J Clin Pharmacol
48: 512-517
[Abstract][Full Text]
Price, N., Boxall, E. H.
(2007). Treatment of children persistently infected with hepatitis B virus: seroconversion or suppression. J Antimicrob Chemother
60: 1189-1192
[Abstract][Full Text]
Kelly, D.
(2006). Viral hepatitis B and C in children. JRSM
99: 353-357
[Full Text]
Guo, Y., Guo, H., Zhang, L., Xie, H., Zhao, X., Wang, F., Li, Z., Wang, Y., Ma, S., Tao, J., Wang, W., Zhou, Y., Yang, W., Cheng, J.
(2005). Genomic Analysis of Anti-Hepatitis B Virus (HBV) Activity by Small Interfering RNA and Lamivudine in Stable HBV-Producing Cells. J. Virol.
79: 14392-14403
[Abstract][Full Text]
Lin, C-L, Tsai, S-L, Lee, T-H, Chien, R-N, Liao, S-K, Liaw, Y-F
(2005). High frequency of functional anti-YMDD and -mutant cytotoxic T lymphocytes after in vitro expansion correlates with successful response to lamivudine therapy for chronic hepatitis B. Gut
54: 152-161
[Abstract][Full Text]
Hochman, J. A., Balistreri, W. F.
(2003). Chronic Viral Hepatitis: Always Be Current!. Pediatr. Rev.
24: 399-410
[Full Text]
Glanville, A.R., Estenne, M.
(2003). Indications, patient selection and timing of referral for lung transplantation. Eur Respir J
22: 845-852
[Abstract][Full Text]
Connor, F L, Rosenberg, A R, Kennedy, S E, Bohane, T D
(2003). HBV associated nephrotic syndrome: resolution with oral lamivudine. Arch. Dis. Child.
88: 446-449
[Abstract][Full Text]
Karayiannis, P.
(2003). Hepatitis B virus: old, new and future approaches to antiviral treatment. J Antimicrob Chemother
51: 761-785
[Abstract][Full Text]