恩替卡韋治療乙肝病毒感染之後，換拉米夫定導致病毒學反

StephenW

             http://www.news-medical.net/news/20110401/14729/Simplified-Chinese.aspx

耐藥率在12％的患者切換到看拉米夫定

恩替卡韦一个为期两年的试验拉米夫定对慢性乙型肝炎病毒（HBV）感染患者（林），其次导致了24％和12％的耐药率的病毒学反弹率。恩替卡韦治疗的患者谁继续在整个学习期间曾在两年不到HBV DNA的端点。这个试验的详情载于四月号肝病研究出版杂志 ，期刊的代表威利- Blackwell的对美国协会。
世界卫生组织（WHO）估计，超过全球有20亿人感染了乙肝病毒，这些案件约360万是慢性感染，可导致肝硬化及肝细胞癌（肝癌）。林是第一个口服抗病毒药物可用来治疗慢性疾病恶化抑制乙肝病毒感染。然而，由元朗等人2007年的研究。确定长期与林治疗与76％耐药性后八年比率。近年来，有研究显示恩替卡韦在减少，只有1.2％的耐药率五年后乙肝病毒的DNA，优于林。
在目前的试验中，冯有光，医师和教授文凤园，医学博士率领的香港大学调查，该小组是否乙肝病毒DNA的初始更有效抗病毒药物，恩替卡韦抑制，可维持切换到林，一个不太强大的和低成本的抗病毒药物。对于耐药性和抗病毒治疗的序贯疗法治疗两个病毒学反弹的潜力也受到审查。 “慢性乙肝患者大部分需要长期抗病毒治疗，一些患者开始选择与林为节省成本的原因治疗。我们的目的是确定初步交换恩替卡韦治疗后，林的疗效和耐药性地位，”说冯博士。
研究人员招募慢性乙肝病毒最初与谁都是恩替卡韦（0.5毫克）治疗至少六个月前的50名患者在研究开始。一个正常的谷丙转氨酶（ALT）水平与HBV DNA转阴须在纳入研究。参加者随机分为武器在第一手臂继续接受第二切换到每天100毫克，林手臂恩替卡韦每日0.5毫克的病人和病人。常规肝功能，乙肝血清学检测，测量和HBV DNA的演出在0，4，12，24，48，72和96周。
结果表明，100年继续对乙型肝炎病毒DNA检测不到的恩替卡韦的病人只手臂％，而参加24％谁切换到经验丰富的林病毒学反弹。研究人员指出，病毒学反弹，随着时间的推移不断增加，患者表现为两个96周，HBV DNA的增加一。此外，三例（12％）开发林性。 “前恩替卡韦抑制乙肝病毒DNA与不提供任何明显的优势谁的病人改用林，”丰博士总结说。 “潜在的成本节约切换到林的好处是没有意识到由于抗药性的发展。”

  




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StephenW

Resistance Rate of 12% Seen in Patients Switched to Lamivudine
A two-year trial of entecavir followed by lamivudine (LAM) in patients with chronic hepatitis B virus (HBV) infection resulted in a virologic rebound rate of 24% and 12% drug-resistance rate. Patients who continued on entecavir therapy throughout the study period had undetectable HBV DNA at the two-year endpoint. Details of this trial are published in the April issue of Hepatology, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases.
The World Health Organization (WHO) estimates that more than 2 billion people worldwide have been infected with HBV; roughly 360 million of these cases are chronic infection that could lead to liver cirrhosis and hepatocelluar carcinoma (liver cancer). LAM is the first oral antiviral agent available to treat chronic HBV infection by inhibiting disease progression. However, a 2007 study by Yuen et al. determined that long-term treatment with LAM is associated with a 76% drug-resistance rate after eight years. In recent years, studies have shown entecavir to be superior to LAM in reducing HBV DNA, with only a 1.2% drug-resistance rate after five years.
In the current trial, James Fung, M.D., and the team led by Professor Man-Fung Yuen, M.D., Ph.D., from The University of Hong Kong, investigated whether initial HBV DNA suppression by the more potent antiviral agent, entecavir, could be maintained by switching to LAM, a less potent and lower-cost antiviral. The potential for drug-resistance and virological rebound with sequential therapy of the two antiviral therapies was also examined. "Most patients with chronic HBV require long-term antiviral treatment and some patients opt to start with LAM therapy for cost-saving reasons. Our aim was to determine the efficacy and drug-resistance profile of switching to LAM after initial entecavir treatment," said Dr. Fung.
    Researchers recruited 50 patients with chronic HBV who were all initially treated with entecavir (0.5 mg) for at least six months prior to the start of the study. A normal alanine aminotransferase (ALT) level and undetectable HBV DNA were required for inclusion in the study. Participants were randomized into two arms with patients in the first arm continuing to receive 0.5 mg of entecavir daily and patients in the second arm switching to 100 mg LAM daily. Routine liver biochemistry, hepatitis B serological test, and HBV DNA measurements were performed at 0, 4, 12, 24, 48, 72, and 96 weeks.
Results showed that 100% of patients in the entecavir-only arm continued to have undetectable HBV DNA, while 24% of participants who switched to LAM experienced virological rebound. Researchers noted that virological rebound continues to increase over time as two patients showed an increased in HBV DNA at 96 weeks. Additionally, three patients (12%) developed LAM-resistance. "Prior HBV DNA suppression with entecavir did not offer any significant advantage to patients who switched to LAM," concluded Dr. Fung. "The potential cost-saving benefit of switching to LAM was not realized due to the development of resistance."
http://onlinelibrary.wiley.com/doi/10.1002/hep.24192/abstract

lyq2003526

没看懂，谁来用1两句话概括一下文章所要表达的意思。

天行健君

先用恩替治疗到DNA转阴以后,为了节省费用转用拉米继续治疗,结果有部分病人出现病毒反弹.

lyq2003526

拉米耐药引起？

在骆先生的博客，曾看到：对于大三恩替卡韦治疗dna阴转后，“用拉米夫定和阿德福韦，因为换药的时候病毒已经转阴，所以3、4年内，出现耐药的非常少”。

StephenW

lyq2003526 发表于 2011-4-4 20:37
拉米耐药引起？

在骆先生的博客，曾看到：对于大三恩替卡韦治疗dna阴转后，“用拉米夫定和阿德福韦，因为 ...

临床试验: 3/25 (12%) 名病人, 两年拉米夫定后, 耐药.

lin12345

病毒转阴后再换拉米  按理耐药不会那么高吧？

lin12345

StephenW

lin12345 发表于 2011-4-5 20:10
病毒转阴后再换拉米  按理耐药不会那么高吧？

"病毒转阴" 是因为使用药物来控制病毒复制. 停药, 换药, 不保证病毒继续转阴.

lyq2003526

这是国内网站的报道，写的比google翻译的好理解。
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恩替卡韦和拉米夫定序贯治疗可致乙型肝炎病毒学反弹
    据ScienceDaily网站报道，一项为期两年的恩替卡韦与拉米夫定（LAM）序贯治疗慢性乙型肝炎病毒（HBV）感染患者的试验显示，病毒学反弹率为24％和耐药率为12％。整个研究期间继续接受恩替卡韦治疗的患者在两年的终点时HBV DNA处于不可检测水平。这项试验刊登在由Wiley-Blackwell出版的4月刊《Hepatology》上。
    在当前试验中，James Fung博士和领导该研究小组的香港大学的Man-Fung Yuen博士研究了更有效的抗病毒药物恩替卡韦对HBV DNA的初始抑制效应是否可由转用一个不太强效且低成本的抗病毒药物LAM来维持。这两种抗病毒药物序贯疗法的耐药性和病毒学反弹的可能性已被证实。“大部分慢性乙肝患者需要长期抗病毒治疗，一些患者首先选择采用LAM治疗，以节省医疗费用。我们旨在确定初始采用恩替卡韦治疗后，转向LAM治疗的疗效和耐药性，”Fung博士说。
    研究人员招募了50名慢性乙肝患者，在试验开始前他们均采用了至少6个月的恩替卡韦（0.5mg）初步治疗。该项试验包括一个正常的谷丙转氨酶（ALT）水平与不可探测的HBV DNA水平。受试者被随机分为两组，一组患者每日继续接受0.5 mg恩替卡韦，另一组患者转向每日接受100 mg LAM。在0、4、12、24、48、72、96周时进行常规肝功能、乙肝血清学检测和HBV DNA检测。
    研究结果表明，100%的单纯应用恩替卡韦组患者的HBV DNA继续保持在不可检测水平，而24％的改用LAM 组患者出现了病毒学反弹。研究人员指出，病毒学反弹随着时间推移而不断增加，在96周时2例患者表现出HBV DNA增加。此外，3例（12％）患者发生LAM耐药。Fung博士总结说，“恩替卡韦先前对HBV DNA的抑制对改用LAM的患者无任何明显益处。由于耐药的发生，使转向采用LAM治疗的潜在节约医疗费用利益不能实现。”

来源：药品资讯网信息中心