Lamivudine prevents reactivation of hepatitis B and reduces mortality in immunosuppressed patients: systematic review and meta‐analysis

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Abstract
Summary.  To assess the effects of prophylactic lamivudine on reactivation and mortality following immunosuppressive therapy in hepatitis B surface antigen (HBsAg)‐positive patients, we performed a meta‐analysis. Systematic review and meta‐analysis of randomized and nonrandomized prospective controlled trials and retrospective comparative case series were identified through The Cochrane Hepato‐Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and LILACS. The primary outcomes were virological reactivation, clinical reactivation and mortality. Secondary outcomes included hepatitis B virus (HBV)‐related mortality, liver histology, discontinuation or disruption of immunosuppressive therapy, lamivudine‐resistant HBV strains and adverse events. A total of 21 studies were included, two of which were randomized controlled trials. Clinical and virological reactivation were significantly reduced in the lamivudine group [odds ratio (OR) 0.09; 95% confidence interval (CI) 0.05–0.15 and OR 0.04; 95% CI 0.01–0.14 respectively]. All‐cause mortality was significantly reduced in the lamivudine group (OR 0.36; 95% CI 0.23–0.56) which translates to only 11 patients who need to be treated to prevent one death. Lamivudine significantly reduced HBV‐related mortality, and discontinuations or disruptions of the immunosuppressive treatment. No adverse effects of lamivudine were recorded, and resistance to lamivudine occurred in low rates. We demonstrated a clear benefit of lamivudine in terms of clinical and virological HBV reactivation, overall mortality, HBV‐related mortality and interruptions or discontinuations in the immunosuppressive treatment. Lamivudine should be administered prophylactically to HBsAg‐positive patients who are about to receive immunosuppressive therapy.

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