Experience of Anti-Viral Therapy in Hepatitis B-Associated Membranous Nephropathy, Including Lamivudine-Resistant Strains
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background/Aims: Chronic hepatitis B infection is a common cause of secondary membranous nephropathy (MN) in endemic areas. Lamivudine treatment improves renal outcome in patients with hepatitis B virus-associated MN (HBVMN), but prolonged use leads to the emergence of lamivudine-resistant variants. We describe our experience treating lamivudine-resistant and other strains of HBV-MN with new antiviral drugs. Methods: Of the 89 patients biopsied and diagnosed with MN from 1996 to 2011, 10 positive for hepatitis B surface antigen were recruited for this study. We investigated the clinical courses, therapeutic responses, and prognoses of patients with HBV-MN. Results: The incidence of HBV-MN among the original 89 patients was 11.2%. Of these patients, four were treated with supportive care and six with antiviral drugs. One of the four patients treated with supportive care had a spontaneous remission. Four of the six patients treated with antiviral drugs were given lamivudine, and the other two were given entecavir. Two of the four patients treated with lamivudine achieved complete remission with seroconversion (i.e.,development of anti-hepatitis B e antigen antibodies), whereas the other two had lamivudine-resistant strains, which were detected at 22 and 23 months after lamivudine treatment, respectively. We added adefovir to the treatment regimen for one of these patients, and for the other patient we substituted clevudine for lamivudine. Both of these patients experienced complete remission, as did the two patients initially treated with entecavir, neither of whom showed resistance to the drug. Conclusions: New nucleoside analogues, such as entecavir, adefovir, and clevudine, can be effective for treatment of HBV-MN, including lamivudine-resistant strains.
Abstract
Background/Aims: Chronic hepatitis B infection is a common cause of secondary membranous nephropathy (MN) in endemic areas. Lamivudine treatment improves renal outcome in patients with hepatitis B virus-associated MN (HBVMN), but prolonged use leads to the emergence of lamivudine-resistant variants. We describe our experience treating lamivudine-resistant and other strains of HBV-MN with new antiviral drugs. Methods: Of the 89 patients biopsied and diagnosed with MN from 1996 to 2011, 10 positive for hepatitis B surface antigen were recruited for this study. We investigated the clinical courses, therapeutic responses, and prognoses of patients with HBV-MN. Results: The incidence of HBV-MN among the original 89 patients was 11.2%. Of these patients, four were treated with supportive care and six with antiviral drugs. One of the four patients treated with supportive care had a spontaneous remission. Four of the six patients treated with antiviral drugs were given lamivudine, and the other two were given entecavir. Two of the four patients treated with lamivudine achieved complete remission with seroconversion (i.e.,development of anti-hepatitis B e antigen antibodies), whereas the other two had lamivudine-resistant strains, which were detected at 22 and 23 months after lamivudine treatment, respectively. We added adefovir to the treatment regimen for one of these patients, and for the other patient we substituted clevudine for lamivudine. Both of these patients experienced complete remission, as did the two patients initially treated with entecavir, neither of whom showed resistance to the drug. Conclusions: New nucleoside analogues, such as entecavir, adefovir, and clevudine, can be effective for treatment of HBV-MN, including lamivudine-resistant strains.
참고문헌 (21)
- Jefferson JA, "Therapy of membranous nephropathy associated with malignancy and secondary causes", Semin Nephrol, 23, pp.400~405 (2003)
- Zeng CH, "Etiology and clinical characteristics of membranous nephropathy in Chinese patients", Am J Kidney Dis, 52, pp.691~698 (2008)
- 이은주, "이차성 막성신병증의 원인 및 임상경과", 대한내과학회지, 68(4), pp.407~416 (2005), 대한내과학회
- Lai KN, "Membranous nephropathy related to hepatitis B virus in adults", N Engl J Med, 324, pp.1457~1463 (1991)
- Lai KN, "The therapeutic dilemma of the usage of corticosteroid in patients with membranous nephropathy and persistent hepatitis B virus surface antigenaemia", Nephron, 54, pp.12~17 (1990)
- Conjeevaram HS, "Long-term outcome of hepatitis B virus-related glomerulonephritis after therapy with interferon alfa", Gastroenterology, 109, pp.540~546 (1995)
- Tang S, "Lamivudine in hepatitis B-associated membranous nephropathy", Kidney Int, 68, pp.1750~1758 (2005)
- Liaw YF, "Effects of extended lamivudine therapy in Asian patients with chronic hepatitis B:Asia Hepatitis Lamivudine Study Group", Gastroenterology, 119, pp.172~180 (2000)
- Allen MI, "Two sensitive PCR-based methods for detection of hepatitis B virus variants associated with reduced susceptibility to lamivudine", J Clin Microbiol, 37, pp.3338~3347 (1999)
- Cattran DC, "Cyclosporine in patients with steroid-resistant membranous nephropathy: a randomized trial", Kidney Int, 59, pp.1484~1490 (2001)
- Yuen MF, "Treatment of chronic hepatitis B: evolution over two decades", J Gastroenterol Hepatol, 26(Suppl 1), pp.138~143 (2011)
- Yi Z, "The efficacy of anti-viral therapy on hepatitis B virus-associated glomerulonephritis: a systematic review and meta-analysis", Ann Hepatol, 10, pp.165~173 (2011)
- Lau DT, "Long-term therapy of chronic hepatitis B with lamivudine", Hepatology, 32, pp.828~834 (2000)
- Lok AS, "Chronic hepatitis B", Hepatology, 45, pp.507~539 (2007)
- Fu L, "Sensitivity of L-(-)2,3-dideoxythiacytidine resistant hepatitis B virus to other antiviral nucleoside analogues", Biochem Pharmacol, 57, pp.1351~1359 (1999)
- Tak WY, "Clinical, biochemical, and pathological characteristics of clevudine-associated myopathy", J Hepatol, 53, pp.261~266 (2010)
- Chang TT, "A comparison of entecavir and lamivudine for HBeAg-positive chronic hepatitis B", N Engl J Med, 354, pp.1001~1010 (2006)
- Tenney DJ, "Long-term monitoring shows hepatitis B virus resistance to entecavir in nucleoside-naive patients is rare through 5 years of therapy", Hepatology, 49, pp.1503~1514 (2009)
- Ikee R, "Hepatitis B virus-related membranous nephropathy treated with entecavir", Nephrology, 15, pp.266~ (2010)
- Lai AS, "Viral nephropathy", Nat Clin Pract Nephrol, 2, pp.254~262 (2006)
- Johnson RJ, "Hepatitis B infection and renal disease: clinical, immunopathogenetic and therapeutic considerations", Kidney Int, 37, pp.663~676 (1990)