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Lamivudine and Hepatitis B Reactivation
- Rohit Loomba, MD, MHSc;
- Frank Pucino, PharmD; and
- Gyorgy Csako, MD
- From University of California, San Diego, La Jolla, CA 92093, and National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD 20892.
IN RESPONSE:
We thank Dr. Hsu and colleagues for their comments on our meta-analysis. We agree that corticosteroids play an important role in chemotherapy-induced HBV reactivation, which is why we listed corticosteroid use in a dedicated column in Table 1 of our article. Unfortunately, as apparent from the adjacent chemotherapy column showing administration of CHOP (cyclophosphamide, hydroxydaunomycin, Oncovin [vincristine], and prednisone), patients in the studies by Lau and colleagues (1) and Hsu and associates (2) were both erroneously labeled as not receiving corticosteroids and not reporting corticosteroid use, respectively. We also acknowledge that, instead of being listed as a randomized clinical trial with therapeutic (deferred) lamivudine control groups, the study by Hsu and colleagues (2) was inadvertently classified as prospective with historical control groups in our Table 1 and figures. It should be noted, however, that we quoted the meeting abstract of the study published by the authors (2) and not the article they reference as being quoted (3). Their full manuscript with the cited clinical trial identifier was not published until after the acceptance of our meta-analysis. In addition, the corresponding authors of all the published studies and abstracts included in our meta-analysis were contacted by e-mail for further clarifications but did not respond. The meeting abstract title did not mention that the study was a randomized, controlled study (2), and the title was reworded only later when published in its entirety (3). Because our research synthesis did not pool data from various studies, the apparent misclassification of this study has no effect on the conclusions.
The statement in our Discussion section about the duration of prophylactic lamivudine was based on a direct quote from the Conclusion section of the abstract by Hsu and colleagues (2): “The duration of lamivudine prophylaxis, which can reduce the incidence and severity of HBV reactivation and hepatitis during chemotherapy, may have to be no less than 8 months after completion of chemotherapy.” That is, in the source that we cited, the authors did indeed recommend a specific duration (at least 8 months) of prophylactic lamivudine after discontinuation of chemotherapy (2).
Frank Pucino, PharmD
Gyorgy Csako, MD
National Institutes of Health, U.S. Department of Health and Human Services
Bethesda, MD 20892
Article and Author Information
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Potential Financial Conflicts of Interest: None disclosed.
