Lamivudine is increasingly being used to prevent Hepatitis B reactivation in patients with cancer who test positive for Hepatitis B surface antigen, and are undergoing chemotherapy.
Dr Rohit Loomba and colleagues from California, USA determined whether preventive lamivudine reduces chemotherapy-induced Hepatitis B virus-related morbidity and mortality in patients with cancer who test positive for Hepatitis B surface antigen.
The team searched MEDLINE, Ovid MEDLINE, TOXNET, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials in all languages until 2007.
The researchers identified clinical trials and cohort studies that reported the efficacy of preventive lamivudine versus control on Hepatitis B virus reactivation in patients who tested positive for Hepatitis B surface antigen.
The patients in the trials and studies all received chemotherapy.
Additional requirements for inclusion of studies included minimum sample size of 5 or more patients, and data on Hepatitis B virus-related morbidity and mortality.
The team reported that 2 investigators independently undertook literature searches and data extraction.
A further 2 investigators independently confirmed study eligibility and data retrieval.
The researchers identified a total of 14 studies, of which 2 were randomized, controlled trials, 8 were prospective cohort studies, and 4 were retrospective cohort studies.
The team noted that there were 275 patients in the preventive lamivudine group, and 475 control participants.
The researchers' primary end point was Hepatitis B virus reactivation.
With preventive lamivudine, the relative risk for both Hepatitis B virus reactivation and Hepatitis B virus-related hepatitis ranged from 0.00 to 0.21.
The team found that none of the patients in the preventive lamivudine group developed Hepatitis B virus-related hepatic failure.
Only 4 deaths were attributable to Hepatitis B virus in the preventive lamivudine group.
The research team observed that lamivudine was well tolerated, and noted no adverse effects.
The studies included in the meta-analysis did not consistently report all of the outcomes of interest.
Dr Loomba's team concluded, "Preventive therapy with lamivudine for patients who test positive for Hepatitis B surface antigen and are undergoing chemotherapy may reduce the risk for Hepatitis B virus reactivation, morbidity and mortality."