High-dose intravenous Hepatitis B immunoglobulin may prevent recurrent Hepatitis B virus infection.
However, the cost has limited its widespread use in countries with endemic Hepatitis B virus infection.
Dr Edward Gane and colleagues investigated long-term safety and efficacy of very low doses of intramuscular Hepatitis B immunoglobulin plus lamivudine.
|A low-dose regimen is less than 10% the cost of high-dose regimens|
The research team studied 147 Australian and New Zealand patients between 1996 and 2004.
The patients received low-dose Hepatitis B immunoglobulin plus lamivudine following liver transplantation for Hepatitis B virus-related end-stage liver disease.
Prior to transplantation, patients with detectable serum Hepatitis B virus DNA received lamivudine 100 mg daily.
Posttransplantation, all patients received lamivudine 100 mg daily plus intramuscular Hepatitis B immunoglobulin 400 or 800 IU daily for 1 week, then monthly.
Serum Hepatitis B virus DNA levels were measured prior to lamivudine, at transplantation, and at 12 months posttransplantation.
Serum titers of antibody to Hepatitis B virus surface antigen were measured at 1, 3, and 12 months posttransplantation.
The team found that 31% of patients were Hepatitis B e antigen positive, and 85% were Hepatitis B virus DNA positive prior to transplantation.
The researchers noted that the median duration of pretransplantation lamivudine was 92 days.
Median follow-up posttransplantation was 1860 days.
The researchers observed that Kaplan-Meier patient survival was 92% at 1 year, and 88% at 5 years.
The actuarial risk of Hepatitis B virus recurrence was 1% at 1 year, and 4% at 5 years.
Baseline Hepatitis B virus DNA titer was associated with Hepatitis B virus recurrence.
Dr Gane's team concluded, “Low-dose intramuscular Hepatitis B immunoglobulin plus lamivudine provides safe and effective long-term prophylaxis against recurrent Hepatitis B virus.
“We found that this regimen is less than 10% the cost of the high-dose regimen.”