Review article: chronic hepatitis B – anti-viral or immunomodulatory therapy?

StephenW

<http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2010.04555.x/abstract;jsessionid=3A4BA745B598493EA58D093693CEDF7C.d02t02>

Review article: chronic hepatitis B – anti-viral or immunomodulatory therapy?

V. Rijckborst, M. J. Sonneveld, H. L. A. JanssenArticle first published online:
29 DEC 2010

DOI: 10.1111/j.1365-2036.2010.04555.x
© 2010 Blackwell Publishing Ltd
Issue

Alimentary Pharmacology & Therapeutics
Volume 33, Issue 5, pages 501–513, March 2011

Aliment Pharmacol Ther 2011; 33: 501–513

Summary

Background 
First-line treatment options for chronic hepatitis B (CHB) consist of
nucleos(t)ide analogues with a high barrier to resistance (entecavir and
tenofovir) or the immunomodulatory agent peginterferon (PEG-IFN). The optimal
choice for individual patients remains controversial.

Aim 
To review treatment options for CHB, with a focus on deciding between prolonged
nucleos(t)ide analogue therapy or a finite course of PEG-IFN.

Methods 
A comprehensive literature search was undertaken.

Results 
Long-lasting, treatment-maintained suppression of hepatitis B virus (HBV) DNA
without resistance is achievable in most patients by entecavir or tenofovir. A
sustained off-treatment response is, however, unlikely and long-term therapy
must be anticipated. PEG-IFN offers a higher rate of sustained response in a
subgroup of patients, but is frequently complicated by side effects.
Pre-treatment predictors of response, including HBV genotype, alanine
aminotransferase and HBV DNA levels, aid in selecting patients for PEG-IFN
therapy. Furthermore, on-treatment markers such as quantitative hepatitis B
surface antigen may be applied to identify nonresponders early during the
PEG-IFN treatment course, thereby preventing unnecessary treatment.

Conclusions 
Both nucleos(t)ide analogues and PEG-IFN can be prescribed as first-line
treatment options for CHB. However, PEG-IFN should only be considered for
patients with a high chance of response based on pre-treatment and on-treatment
factors.

评论文章：慢性乙型肝炎 - 抗病毒或免疫调节治疗？

五，Rijckborst，兆焦耳Sonneveld和HLA JanssenArticle首次在网上公布：
2010年12月29日

分类号：10.1111/j.1365-2036.2010.04555.x
© 2010布莱克韦尔出版有限公司
发行

消化系统药理学与治疗学
33卷，第5期，页501-513，2011年3月

营养品药理学有2011，33：501-513

综述

背景
慢性乙型肝炎一线治疗方案（乙肝）的组成
核苷（酸）具有高障碍性（恩替卡韦和IDE类似物
泰诺福韦）或免疫调节剂长效干扰素（聚乙二醇干扰素）。最佳
个别病人的选择仍存在争议。

目的
审查决定之间长期为慢性乙型肝炎的治疗方案，重点是
核苷（酸）类似物治疗的IDE或聚乙二醇干扰素有限的课程。

方法
阿进行了全面文献检索。

结果
长效，治疗维持的抑制乙型肝炎病毒（HBV）的DNA
不反抗是恩替卡韦或替诺福韦中大多数患者可以实现的。一
持续了处理响应，但是，不太可能和长期治疗
必须预期。聚乙二醇干扰素提供了一个持续应答率较高
子群的病人，但经常被副作用复杂。
前处理预测的反应，包括乙肝病毒基因型，丙氨酸
转氨酶和乙肝病毒DNA水平，帮助选择聚乙二醇干扰素的病人
治疗。此外，诸如乙肝定量处理标记
表面抗原可用于识别在早期无应答
聚乙二醇干扰素治疗过程中，从而避免不必要的治疗。

结论
这两种核苷（酸）类似物的IDE和PEG -干扰素可规定为第一线
对慢性乙型肝炎的治疗方案。然而，聚乙二醇化干扰素只应考虑
应对患者进行高预治疗的基础上的机会和待遇
因素。