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标题: 六年替诺福韦DF治疗慢性乙型肝炎病毒感染的治疗是安全和耐 [打印本页]

作者: StephenW 时间: 2013-6-20 19:58 标题: 六年替诺福韦DF治疗慢性乙型肝炎病毒感染的治疗是安全和耐

SixYears of Treatment With Tenofovir DF for ChronicHepatitis B Virus Infection is Safe and Well Tolerated and Associated WithSustained Virological, Biochemical, and Serological Responses With NoDetectable Resistance

Reportedby Jules Levin

AsianPacific Association for the Study of the Liver (APASL) Liver Week, June 6–10,2013, Singapore

NaokyTsai1, Maria Buti2, Edward Gane3, William Sievert4, Ira M. Jacobson5, PhillipDinh6, John F. Flaherty6, Kathryn M. Kitrinos6, John G.McHutchison6, GeorgeGermanidis7, Patrick Marcellin8

1University of Hawaii atManoa, Honolulu, HI, USA; 2Hospital General Universitari Vall d’Hebron andCiberehd, Barcelona, Spain; 3Auckland City Hospital, Auckland, New Zealand; 4Monash University andMonash Medical Centre, Melbourne, VIC, Australia; 5Weill Cornell MedicalCollege, New York, NY, USA; 6Gilead Sciences, Inc., FosterCity, CA, USA; 7AHEPA University Hospital, Aristotle University Medical School,Thessaloniki, Greece; 8Hôpital Beaujon, Clichy, France

CONCLUSIONS

Virologic, biochemical, and serologic responses were maintained through 6 years
   – Sustained virologic suppression remained consistent with Year 5 results
   – HBeAg loss/seroconversion rates of 50%/37% through 6 years
   – 11% of patients had confirmed HBsAg loss (8% with seroconversion)

No resistance to TDF was detected through 6 years
   – No conserved site changes seen; all polymorphic site changes were unique
   – 7 of 8 patients eligible for genotyping had documented non adherence

Treatment with TDF was well tolerated
   – 80% of 585 patients entering the open-label phase remained on study at Year 6; 73% of enrolled patients remained on study
   – <2% of patients discontinued TDF due to an AE
   – Renal AEs were uncommon (≤1.5%) and manageable with dose modification
   – No evidence of bone loss over 2-year follow-up

作者: StephenW 时间: 2013-6-20 20:01

通过6年保持病毒学，生化及血清学反应
>  -  5年业绩持续病毒学抑制保持一致
>  -  HBeAg转阴/血清学转换率分别为50％/ 37％，至6年
>  -  11％的患者已证实HBsAg消失与血清学转换（8％）
>
> TDF无耐药检测到6年
>  - 没有保守站点变化看到所有多态位点的变化是独一无二的
>  -  7 8例获基因型记录不遵守
>
> TDF治疗的耐受性良好
>  -  80％的585名患者进入开放标签阶段仍然保持在6年的研究，73％的参加试验的患者研究
>  -  <2％的患者停止TDF由于AE
>  - 肾功能不良是少见（≤1.5％）和剂量修改管理
>  - 骨量丢失超过2年没有证据表明后续

作者: 希望奇迹 时间: 2013-6-21 08:18

我先吃几年恩替，再吃几年替诺，与HBV打持久战！

作者: 卡奥卡 时间: 2013-6-21 10:45

HBeAg转阴/血清学转换率分别为50％/ 37％，至6年这条数据是亮点啊！加油啊！科学家们！！！

作者: 疯一点好 时间: 2013-6-21 11:26

问斯蒂文，你知道对于吃了5年以上贺维力的人如果发生耐药，还可以转服替诺吗？转服效果如何呢，实在不行我就趁早换成替诺，能给点好建议吗？

作者: 疯一点好 时间: 2013-6-21 11:28

原有报道说，所有吃替诺的只有11%大三阳可能表面抗原转阴，小三阳不行。

作者: StephenW 时间: 2013-6-21 16:32

回复疯一点好的帖子

你知道对于吃了5年以上贺维力的人如果发生耐药，还可以转服替诺吗？据安娜·乐教授(Prof Anna Lok)，阿德福韦耐药(以前没有拉米夫定耐药)，改用恩替卡韦(Entecavir)或添加恩替卡韦(Entecavir).

转服效果如何呢 - Studies in clinical practice have shown high rates of virologic response in adefovir-resistant patients who switched to entecavir.[Reijnders 2010a; Zoutendijk 2011; Sheen 2011] Indeed, one study showed that, of 8 patients with adefovir resistance who switched to entecavir monotherapy, all achieved HBV DNA < 100 IU/mL and 7 out of 8 achieved a biochemical response, defined as alanine aminotransferase < 40 U/L after 12 months of treatment.[Sheen 2011]
在临床实践中的研究已经表明改用恩替卡韦阿德福韦耐药患者的病毒学应答率很高。Reijnders2010A;2011年Zoutendijk;辛2011]事实上，一项研究表明，阿德福韦耐药，改用恩替卡韦单药治疗8例，所有达到HBV DNA<100 IU/ mL和78定义为丙氨酸氨基转移酶的生化反应，<40 U / L后12个月的治疗。[辛2011]

实在不行我就趁早换成替诺，能给点好建议吗？单独替诺并不是最佳抢救阿德福韦耐药.

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