바이러스 돌파현상 후 급성 악화를 보인 만성 B형간질환 환자에서 라미부딘 투여 지속군과 중지군의 임상비교
Comparison of Clinical Outcome Between Patients Continuing and Discontinuing Lamivudine Therapy in Acute Exacerbation After Viral breakthrough During Lamivudine Therapy in Chronic Hepatitis B
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목적: 만성 B형간질환에서 라미부딘 치료 중 바이러스 돌파현상이 발생하더라도 라미부딘을 계속 투여하도록 권장하였으나 급성 악화가 생겼을 때는 임상경과에 대한 연구 결과가 충분치 않아 치료지침 또한 아직 불명확하다. 이에 저자들은 바이러스 돌파현상 후 급성 악화가 생겼을 때 라미부딘 지속여부에 따른 임상경과를 조사하여 라미부딘의 지속투여가 치료 의미가 있는지를 알아보고자 하였다. 대상과 방법: 만성 B형간질환으로 라미부딘 치료 중 바이러스 돌파현상을 보인 109명에 대해 후향적으로 조사하였다. 비대상 간질환 혹은 바이러스 돌파현상 후 비대상 악화를 보이는 경우는 제외하였고 바이러스 돌파현상 후 ALT치가 정상 상한치의 5배 이상으로 급성 악화를 보인 40명(평균나이 42.6세; 남/녀 34/6) 중 아데포비어의 투여가 가능하였던 2명을 제외한 38명에서 라미부딘 치료를 지속한 군(n=21)과 중단한 군(n=17) 사이의 임상경과를 비교하였다. 통계분석은 Fisher's exact test로 하였고 P값이 0.05 미만일 때를 통계적으로 유의하다고 하였다. 결과: 급성 악화 후 추적 기간은 평균 27개월(범위 6-60개월)이었다. 라미부딘 투여를 지속한 21명에서 ALT치가 정상 상한치의 2배 이하로 다시 감소한 경우가 11명(52%), 2배에서 5배 사이에서 변동한 경우가 9명(43%), 5배 이상 지속적으로 증가한 경우가 1명(5%)에서 있었고, 중지한 17명에서는 각각 9명(53%), 5명(29%), 3명(18%)이었다. 두 군간 ALT치 변화의 차이는 없었다(P=.417). 결론: 대상 만성 B형간질환 환자에서 라미부딘 치료 중 바이러스 돌파현상 후 ALT치의 급성 악화가 생겼을 때 라미부딘 투여 지속은 중단하는 것보다 득이 없었다.
Abstract
Backgrounds/Aims: Continuation of lamivudine therapy is controversial for patients with chronic hepatitis B when viral breakthrough occurs. Moreover, the effect of continuous lamivudine therapy is unknown in patients with acute exacerbation after viral breakthrough. We assessed clinical course of acute exacerbation after viral breakthrough in patients who continued and discontinued lamivudine therapy. Methods: Medical records of 109 patients with viral breakthrough during lamivudine therapy were reviewed. Of 40 patients with acute exacerbation (ALT level >5×ULN), adefovir dipivoxil was unavailable in 38 patients. These 38 patients (mean age 42.6 years; male/female, 34/6) were divided into continuation (n=21) and discontinuation (n=17) groups. Clinical courses of the 2 groups were compared. Results: During follow- up period (mean, 27 months; range, 6-60 months), ALT levels decreased to <2×ULN in 11 patients (52%) of continuation group and 9 patients (53%) of discontinuation group, varied from 2× to 5×ULN in 9 (43%) and 5 (29%), respectively, and increased to >5×ULN in 1 (5%) and 3 (18%), respectively, with no statistical significance (P=.417). Conclusions: When acute exacerbation of ALT levels occurs after viral breakthrough during lamivudine administration in patients with compensated chronic hepatitis B, continuation of lamivudine may have no advantage over discontinuation.
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