Lamivudine versus entecavir in the rescue of chemotherapy-induced hepatitis B flare-up.

BACKGROUND: Lack of nucleos(t)ide analogue (NA) prophylaxis prior to chemotherapy is a common problem worldwide. The efficacy of newer-generation NAs in the rescue for the hepatitis B virus (HBV) reactivation has not been confirmed. We aimed to compare lamivudine (LVD) and entecavir (ETV) in the rescue of chemotherapy-induced HBV flare-up.

METHODS: In this retrospective cohort study, we screened all HBV carriers who received therapeutic LVD or ETV for hepatitis flare-up after chemotherapy between January 1, 2004 and December 31, 2015. Patients who had other concurrent primary liver diseases such as chronic hepatitis C, who had baseline HBV viral load <2000 IU/ml or data unavailable, or those who had primary or secondary liver cancers were excluded. By means of propensity scores, LVD users were randomly matched 1:1 with ETV users. Cumulative incidences of, and hazard ratios (HRs) for, mortality at 6 months were analyzed, and 1-year virological responses were evaluated.

RESULTS: In total, 32 LVD and 32 ETV users were matched for outcome analysis, and their baseline characteristics were not significantly different. Comparing LVD users to ETV users, the 6-month liver-related mortality rates (6.3% vs. 12.5%, p = 0.47) and overall mortality rates (31.3% vs. 25%, p = 0.54) were not significantly different. In multivariate analysis, prothrombin time prolongation >4 s (HR: 10.78, 95% confidence interval [CI]: 1.55-74.93) and HBV viral load L (HR: 3.40 per 1 log IU/ml, 95% CI: 1.39-8.40) were independent prognostic factors for liver-related mortality. There was no drug resistance to LVD or ETV over the course of 1 year.

CONCLUSION: Clinical outcomes were not different between LVD and ETV users. Delayed detection of hepatitis flare-up with coagulopathy and a high viral load could result in a poor prognosis.