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标题: [英语,临床]Long-term efficacy of entecavir therapy in chronic hepatitis B [打印本页]

作者: StephenW    时间: 2011-5-18 03:11     标题: [英语,临床]Long-term efficacy of entecavir therapy in chronic hepatitis B

本帖最后由 风雨不动 于 2012-4-14 15:17 编辑

请当心分析这个摘要:
1.需要阅读整份文件
2.样本小
3.样本似乎包括难以治疗的病人
4.病毒突破是没必有对恩替卡韦耐药性,需要阅读整份文件
[我个人的意见, StephenW]

<http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2893.2011.01461.x/abstract>

Long-term efficacy of entecavir therapy in chronic hepatitis B patients
with antiviral resistance to lamivudine and adefovir

M. S. Kwak1, J. W. Choi1, J. S. Lee2, K. A. Kim2, J. H. Suh1, Y. S. Cho1,
S. Y. Won1, B. K. Park1, C. K. Lee1

Article first published online: 13 MAY 2011

DOI: 10.1111/j.1365-2893.2011.01461.x
© 2011 Blackwell Publishing Ltd
Issue

Journal of Viral Hepatitis
Early View (Online Version of Record published before inclusion in an
issue)

Summary.  No studies have reported the long-term effects of entecavir
switching in patients with multidrug resistance who developed resistance
after lamivudine/adefovir sequential therapy. We evaluated the efficacy of
96 weeks of entecavir therapy in patients with resistance to
lamivudine/adefovir sequential therapy. In total, 33 patients with chronic
hepatitis B virus (HBV) infection with evidence of active viral replication
(HBV DNA levels ≥105 copies/mL) or a history of treatment failure to
lamivudine/adefovir sequential therapy between April 2007 and July 2009
were treated with entecavir (1.0 mg daily) for at least 48 weeks. The rates
of alanine transaminase (ALT) normalization and HBV DNA negativity were
66.7% (14/21) and 24.2% (8/33) at 48 weeks, respectively. The initial HBV
DNA level was the only factor that was inversely associated with serum HBV
DNA negativity after 48 weeks of entecavir therapy (P < 0.023). At 96
weeks, the rates of ALT normalization and HBV DNA negativity were 77.8%
(7/9) and 16.7% (3/18), respectively. Viral breakthrough occurred in 21.2%
(7/33) and 78.9% (15/19) of patients at 48 and 96 weeks, respectively.
Patients who achieved a HBV DNA level of <4 log10 copies/mL at 48 weeks
maintained a similar HBV DNA level and a normal ALT level until 96 weeks.
Entecavir monotherapy for 96 weeks was not efficacious for patients with
lamivudine/adefovir-resistant HBV. The initial HBV DNA level was the only
predictive factor for antiviral efficacy. However, patients who achieved a
HBV DNA level of <4 log10 copies/mL with a normal ALT level at 48 weeks
should maintain, rather than stop, entecavir therapy.



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作者: StephenW    时间: 2011-5-18 03:13

长期疗效恩替卡韦治疗慢性乙型肝炎患者
抗病毒药物拉米夫定和阿德福韦抗

微软Kwak1,JW Choi1,江苏Lee2,嘉Kim2,Jh的Suh1,永生Cho1,
士元夺得一,二光园1,曾振李一

文章首先发表时间:2011年5月13日

分类号:10.1111/j.1365-2893.2011.01461.x
© 2011布莱克韦尔出版有限公司
发行

作者:病毒性肝炎
早期查看(网络版日前发表记录列入一
问题)

综述。没有研究报告的恩替卡韦的长期影响
患者多药耐药开关电阻谁开发
后拉米夫定/阿德福韦序贯疗法。我们评估的疗效
96恩替卡韦治疗的患者抗周
拉米夫定/阿德福韦序贯疗法。总共有33例慢性
乙型肝炎病毒(HBV)感染与病毒复制活跃的证据
(乙肝病毒DNA水平≥105拷贝/ mL)或治疗失败的历史
拉米夫定/阿德福韦序贯疗法2007年4月至2009年7月
分别用恩替卡韦(1.0毫克)至少48周。率
为丙氨酸转氨酶(ALT)正常化和HBV DNA阴转
66.7%(14/21)和24.2%,至48周(8 / 33),分别为。最初的乙肝病毒
DNA水平的唯一因素呈负相关,与血清乙肝病毒
DNA阴转恩替卡韦治疗后48周(P <0.023)。在96
周后,ALT复常和HBV DNA阴转率分别为77.8%
(7 / 9)和16.7%(3 / 18),分别为。发生病毒突破21.2%
(7 / 33)和78.9%(15/19)的患者在48和96周。
谁取得患者在48周乙肝病毒的DNA <4 log10拷贝水平/毫升
保持了类似的乙肝病毒DNA水平与正常,直到96周ALT水平。
恩替卡韦单药治疗96周不适合病人的疗效与
拉米夫定/阿德福韦抗乙肝病毒。乙肝病毒DNA水平的初始是唯一
抗病毒疗效的预测因子。然而,患者谁取得一
乙型肝炎病毒DNA水平<4 log10拷贝/ mL,且在48周ALT​​水平正常
应保持,而不是停止,恩替卡韦治疗。
作者: kennyu    时间: 2011-5-18 14:11

回复 StephenW 的帖子

我不反对高DNA载量的携带者进行抗病毒治疗,
但是,王震宇提倡的使用拉米夫定治疗,我个人持反对意见。

这个研究成果应该让人们好好看一下!

作者: bigben446    时间: 2011-5-18 16:59

kennyu 发表于 2011-5-18 14:11
回复 StephenW 的帖子

我不反对高DNA载量的携带者进行抗病毒治疗,

逻辑可能是这样的,没看到全文。
At 96 weeks, the rates of ALT normalization and HBV DNA negativity were 77.8% (7/9) and 16.7% (3/18), respectively. Viral breakthrough occurred in 21.2% (7/33) and 78.9% (15/19) of patients at 48 and 96 weeks, respectively.
所以:
Entecavir monotherapy for 96 weeks was not efficacious for patients with lamivudine/adefovir-resistant HBV.
---------------------------------------------------------------------------------------------
Patients who achieved a HBV DNA level of <4 log10 copies/mL at 48 weeks maintained a similar HBV DNA level and a normal ALT level until 96 weeks.
所以:
The initial HBV DNA level was the only predictive factor for antiviral efficacy. However, patients who achieved a HBV DNA level of <4 log10 copies/mL with a normal ALT level at 48 weeks should maintain, rather than stop, entecavir therapy.
标题的Long-term是96周,2年时间。

作者: kennyu    时间: 2011-5-18 22:06

回复 bigben446 的帖子

我想问题的关键是,初始治疗使用拉米夫定之后,一旦耐药,恩替卡韦的治疗效力也会大打折扣。这个是非常难以接受的一个结果。

对于国内的病人而言,恩替卡韦应该是性价比都比较好的一个药物了。
如果可以,初次治疗应该使用,替诺福韦也很好,但是,短时间内价格疗效比,没有太多的优势。


作者: kennyu    时间: 2011-5-18 22:10

回复 bigben446 的帖子

我们可以把与王震宇大夫的讨论帖置顶,同时附上你方的论据(这个结果就非常有力的驳斥了“初治拉米论”),孰优孰劣,我想多数人还是能够明白的。


作者: bigben446    时间: 2011-5-18 22:45

kennyu 发表于 2011-5-18 22:10
回复 bigben446 的帖子

我们可以把与王震宇大夫的讨论帖置顶,同时附上你方的论据(这个结果就非常有力的 ...

本来回了又删了,主要不想成为王震宇话题的水贴,不过某种意义上吵架也会让很多人知道拉米攻略违背治疗指南的地方,版主区还有好多,没有贴出来,版主们、管理员都没统一意见。。。





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