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这是基于日本治疗指导方针。 请注意:
1。Tenofovir尚未获批准在日本
2。 它建议服用拉米夫定的换entecavir 如果没有病毒突破,
3。 它建议服用拉米夫定的+adefovir 如果病毒突破(一份报告指出,发生adefovirdipovoxil耐药一年后为21%,但服用拉米夫定和adefovir这两个组合的耐药率下降的速度明显,1.6%2年后.这是假定的,因为每个服用拉米夫定和adefovir抗敏感地注意到其他的病毒的两种药物。)
TREATMENT DESIGN FOR DECREASE
IN APPEARANCE OF LAMIVUDINERESISTANT
VIRUS
IN JAPAN, IN conjunction with the introduction of
entecavir in 2006, the 2007 version of MHLW’s guidelines
recommended a switch from lamivudine, with its
high incidence of drug-resistant virus, to entecavir, for
which the incidence of drug-resistant virus is low.5,6
Dividing of the administration period into 3 years or
more and less than 3 years, the guidelines initially called
for a proactive switch to entecavir in cases for which the
duration of lamivudine administration was less than
3 years and accompanied by persistent HBV DNA level
<2.6 log copies/mL (afterward, 2.1 log copies/mL). Even
in cases for which the administration period is 3 years or
more accompanied by normal ALT level and persistent
HBV DNA level <2.6 log copies/mL, the potential is
high for diagnosis of lamivudine-resistant virus. The
guidelines therefore now call for combination therapy
by addition of adefovir when viral breakthrough is
observed, alongside continued administration of lamivudine.
Nevertheless, one paper reporting on a randomized
control study of cases treated with lamivudine for a
period of at least 3 years accompanied by HBV DNA
level <2.6 log copies/mL, based on comparison of drug resistant
virus incidence between cases whose treatment
was switched to entecavir and cases for whom lamivudine
treatment was continued, found that the group
treated with continued lamivudine exhibited drug resistant
virus development, while the group treated
with entecavir experienced no such appearance of drug resistant
virus.33
With such a situation as background, beginning with
the 2010 version, the MHLW guidelines recommend34
Table 2 2010–2011 guidelines of the Japanese Ministry of
Health, Labour and Welfare’s research team34: Lamivudine to-
entecavir switching treatment in lamivudine-pretreated
patients that, for cases with persistent HBV DNA level <2.1 log
copies/mL, regardless of duration of lamivudine administration,
a switch to entecavir be made as a general rule
(Table 2).
HBV DNA level Regimen of therapy
<2.1 log copies/mL, As a general rule, switch to entecavir
sustained (0.5 mg/day)
>= 2.1 log copies/mL
VBT - Switch to entecavir (0.5 mg/day) is
feasible.
VBT + Add adefovir (10 mg/day)
HBV, hepatitis B virus; VBT, viral breakthrough.
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楼主: z3f
发表于 2012-4-21 17:01
