İmmün baskılayıcı tedavi alanların HBV reaktivasyonunu engellemede potent antivirallerin daha etkili olduğu tartışması sürmekte ve direnç üzerinde durulmakta

İmmün baskılayıcı tedavi alanların HBV reaktivasyonunu engellemede potent antivirallerin daha etkili olduğu tartışması sürmekte ve direnç üzerinde durulmakta

JAMA. 2014 Dec 17;312(23):2521-30. doi: 10.1001/jama.2014.15704.
Entecavir vs lamivudine for prevention of hepatitis B virus reactivation among patients with untreated diffuse large B-cell lymphoma receiving R-CHOP
chemotherapy: a randomized clinical trial.
Huang H1, Li X1, Zhu J2, Ye S3, Zhang H4, Wang W5, Wu X6, Peng J7, Xu B8, Lin Y9, Cao Y10, Li H1, Lin S11, Liu Q12, Lin T1.
Abstract

IMPORTANCE:
Hepatitis B virus (HBV) reactivation is a serious complication for patients with lymphoma treated with rituximab-containing chemotherapies, despite lamivudine prophylaxis treatment. An optimal prophylactic antiviral protocol has not been determined.

OBJECTIVE:
To compare the efficacy of entecavir and lamivudine in preventing HBV reactivation in patients seropositive for the hepatitis B surface antigen with untreated diffuse large B-cell lymphoma receiving chemotherapy treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP).

DESIGN, SETTING, AND PATIENTS:
Randomized, open-label, phase 3 study conducted from February 2008 through December 2012 at 10 medical centers in China. This study was a substudy of a parent study designed to compare a 3-week with a 2-week R-CHOP chemotherapy regimen for untreated diffuse large B-cell lymphoma. Patients enrolled in the parent study who were seropositive for the hepatitis B surface antigen and had normal liver function, serum HBV DNA levels of less than 103 copies/mL, and no prior antiviral therapy were randomized to entecavir (n?=61)or lamivudine (n?=?60).

INTERVENTIONS:
Daily entecavir (0.5 mg) or lamivudine (100 mg) beginning 1 week before the initiation of R-CHOP treatment to 6 months after completion of chemotherapy.

MAIN OUTCOMES AND MEASURES:
The primary efficacy end point was the incidence of HBV-related hepatitis. 
The secondary end points included rates of HBV reactivation, chemotherapy disruption due to hepatitis, and treatment-related adverse events.

RESULTS:
There were 121 patients randomly assigned to receive entecavir (n?=?61) or lamivudine (n?=?60). The date of last patient follow-up was May 25, 2013. 
The rates were significantly lower for the entecavir group vs the lamivudine group for HBV-related hepatitis (0% vs 13.3%, respectively; difference between groups, 13.3% [95% CI, 4.7% to 21.9%]; P?=?.003), HBV reactivation (6.6% vs 30%; difference, 23.4% [95% CI, 10.2% to 36.6%]; P?=?.001), and chemotherapy disruption (1.6% vs 18.3%; difference, 16.7% [95% CI, 6.4% to 27.0%]; P?=?.002). Of the 61 patients in the entecavir group, 15 (24.6%) experienced treatment-related adverse events. Of 60 patients in the lamivudine group, 18 (30%) experienced treatment-related adverse events (difference between entecavir and lamivudine groups, 5.4% [95% CI, -10.5% to 21.3%]; P?=?.50).

CONCLUSIONS AND RELEVANCE:
Among patients seropositive for the hepatitis B surface antigen with diffuse large B-cell lymphoma undergoing R-CHOP chemotherapy, the addition of entecavir compared with lamivudine resulted in a lower incidence of HBV-related hepatitis and HBV reactivation. If replicated, these findings support the use of entecavir in these patients.


JAMA. 2015 Mar 24-31;313(12):1269-70. doi: 10.1001/jama.2015.1438.
Treatment to prevent hepatitis B virus reactivation in patients with lymphoma receiving chemotherapy.
Baang J1.