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肝胆相照论坛 论坛 学术讨论& HBV English 存档 1 阿地福韦耐药情况最新信息(2005.4.15 EASL) ...
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阿地福韦耐药情况最新信息(2005.4.15 EASL) [复制链接]

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旺旺勋章 大财主勋章 如鱼得水 黑煤窑矿工勋章

1
发表于 2005-4-17 07:22

Adefovir HBV Resistance Update

INCIDENCE AND PREDICTORS OF EMERGENCE OF ADEFOVIR RESISTANT HBV DURING FOUR YEARS OF ADEFOVIR DIPIVOXIL (ADV) THERAPY FOR PATIENTS WITH CHRONIC HEPATITIS B (CHB)

S. Locarnini1, X. Qi2, S. Arterburn2, A. Snow2, C.L. Brosgart2, G. Currie2, M. Wulfsohn2, M.D. Miller2, S. Xiong2

1 VIDRL, Melbourne, Australia

2 Gilead Science, Inc., Foster City, CA, USA

Background: Lamivudine-resistant (LAM-R) HBV emerged in 70% of CHB patients by 4 years of LAM therapy. Higher baseline HBV DNA, higher body mass index (BMI), and male were predictors for developing LAM-R (Lai_JID_2003;36:687).

Aims: To determine the incidence of ADV resistance (ADV-R) mutations after 192 weeks of ADV therapy and the predictors for ADV-R.

Methods: This analysis included 629, 293, 221, and 67 patients who received ADV through 48, 96, 144, and 192 weeks, respectively, from 5 studies. At baseline, patients had wild-type or LAM-R HBV. The majority of patients received ADV monotherapy. Most patients with LAM-R HBV received 3 years of ADV+LAM. ADV-R mutations were identified by sequencing HBV RT. The cumulative probability (CP) of ADV-R was calculated using the Life Table method. Logistic regression was used to identify predictors of ADV-R.

Results: 22 patients developed ADV-R mutations (N236T and/or A181V) by 4 years. The incidence per period was 0% (0/629) for 0-48 weeks, 2% (6/293) for 49-96 weeks, 5% (11/217) for 97-144 weeks, and 8% (5/62) for 145-192 weeks. The CP for developing ADV-R by week 192 was 15% for all patients (18% for patients in ADV monotherapy trials). No ADV-R mutations were identified in patients on LAM+ADV. The N236T mutation was observed 4 times more frequently than A181V. Dual mutations A181V(/T)+N236T were observed in 4 (18%) patients. Development of ADV-R mutations was associated with serum HBV DNA rebound (≥1 log) in most patients. Logistic regression analyses of baseline HBV DNA, ALT, race, age, gender, BMI, liver histology, prior HBV therapy, and week 48 HBV DNA identified only higher serum HBV DNA at week 48 (median 4.2 log with ADV-R vs. 3 log without ADV-R) as a predictor of ADV-R.

Conclusions: The cumulative probability of developing adefovir resistance was 15% by 192 weeks of ADV therapy in CHB patients. LAM+ADV combination therapy appears to lower the chance of developing ADV-R. Higher HBV DNA at week 48 during ADV therapy predicted emergence of ADV resistance. The chance of developing resistance was over 4-fold lower with ADV monotherapy compared to that reported for LAM monotherapy by 4 years.

http://www.medhelp.org/user_photos/show/154916?personal_page_id=1697291

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2
发表于 2005-4-17 08:47

结论部分翻译:

对于连续治疗192周的乙肝病毒携带者而言, 阿德福韦的累计抗药性是15%。阿德与拉米联合用药耐药性要低于单独用药,用阿德连续治疗48周时如出现hbv-dna升高的现象可能预示耐药的出现。阿德治疗4年出现耐药概率比用拉米治疗相同时间出现的概率低4倍。

大体如此。

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3
发表于 2005-4-24 10:41

费用方面工薪阶层能承受吗?

那什么价钱啊,普通的工薪阶层能用的起吗?
人生的路是漫长曲折,但请相信明天的阳光是明媚暖人的!

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4
发表于 2005-4-25 00:44
还是耐药啊.
心连心

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5
发表于 2005-4-28 23:54
拜托哪位高手把他翻译成中文吧,太难懂了[em03]

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6
发表于 2005-5-6 03:07
看不懂!

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7
发表于 2007-10-27 03:03

我是大三阳乙肝患者,男,36岁,15病史,拉米两年耐药,后阿德两年耐药,现加用拉米(拉米+阿德)有一个月了。

请问各位战友:

这两种药合在一起会不会在短时间内再耐药?

假如耐药有没有更好的替代品?

谢谢!

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8
发表于 2007-11-3 12:38

郁闷啊,花钱成了一些垃圾医生的实验品,真不知道象我们这样都耐药的患者以后怎么活啊,真想去pk一些无良的医生

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