Flares during HBV Treatment Do Not Predict Response, May Cause Liver Failure

StephenW

Flares during HBV Treatment Do Not Predict Response, May Cause Liver Failure                                                               
Category: HBV Treatment  
Published on Sunday, 12 September 2010 00:00                                                        Written by Liz Highleyman               
                                                                                                

© Russell Kightley

                                       
               
               
Developing hepatic flares, or sudden increases in liver enzymes or viral load, while undergoing nucleoside/nucleotide analog therapy for chronic hepatitis B did not increase the likelihood of sustained viral clearance and led to decompensated liver failure in some patients, researchers reported in the July 2011Journal of Viral Hepatitis.
         N-P. Zhang from Erasmus University Medical Center in Rotterdam and colleagues estimated the frequency and evaluated the outcomes of hepatitis flares during or after stopping hepatitis B treatment with nucleoside/nucleotide analogs, a drug class that includes lamivudine (Epivir-HBV), entecavir (Baraclude), adefovir (Hepsera), and tenofovir (Viread).
        Flares in people with chronic hepatitis B virus (HBV) infection typically indicate worsening or recurrence of active viral replication and immune response to increasing virus. Flares are often detrimental, but they sometimes may lead to sustained immune control of HBV and disease remission, the researchers noted as background. As the immune system attacks HBV in hepatocytes (liver cells), the damaged or dying cells release alanine aminotransferase (ALT). Sudden ALT elevations signal an inflammatory response that could potentially either clear the virus or lead to further liver damage.
        The present analysis included 227 patients who received a total of 351 courses of nucleoside/nucleotide analog therapy for chronic hepatitis B (that is, some people were treated more than once).
        Results

•                 Nucleoside/nucleotide analog therapy was discontinued after 149 courses of treatment (other patients remained on ongoing therapy).
•                 A total of 27 flares were observed during 9779 patient-months of observation while on treatment, for an estimated frequency of 3.2 per 100 person-years.
•                 People treated with lamivudine were the most likely to experience on-treatment hepatic flares (4.9 per 100 person-years).
•                 20 out of 27 flares that occurred while on treatment (74%) were associated with development of drug resistance, all in patients taking lamivudine.
•                 Participants experienced 17 flares following 149 nucleoside/nucleotide discontinuations (11%), occurring a median 3.5 months after stopping therapy.
•                 No flares were observed among 51 participants who switched to other antiviral agents.
•                 None of the flares occurring during or after discontinuation of nucleoside/nucleotide analog therapy were associated with sustained viral clearance or disease remission.
•                 In 7 cases flares were associated with decompensated liver failure.
  

        Based on these findings, the investigators concluded, "In this study, flares related to [nucleoside/nucleotide analog] therapy never led to immune control and sustained disease remission, and sometimes resulted in decompensated liver disease."
        Investigator affiliations: Department of Gastroenterology & Hepatology and Department of Epidemiology & Biostatistics, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China.
        9/13/11
        Reference
        NP Zhang, JGP Reijnders, M Perquin, et al. Frequency and clinical outcomes of flares related to nucleos(t)ide analogue therapy in patients with chronic hepatitis B. Journal of Viral Hepatitis 18(7):e252-e257 (abstract). July 2011.

        




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StephenW

[谷歌翻译是不是100％正确，仅供参考，使用。]
[Flare-升高]
开发肝升高，或肝酶或病毒载量的突然增加，而没有接受治疗慢性乙型肝炎的核苷/核苷酸模拟治疗增加了持续的病毒清除的可能性，并导致在一些患者的肝功能衰竭失代偿的研究人员报告说，在2011年7月中国病毒性肝炎。

N - P。张从伊拉斯谟大学医学中心的“鹿特丹公约”和他的同事估计的频率和评估期间或停药后与核苷/核苷酸类似物恩替卡韦（博路定），一个类药物，包括拉米夫定（Epivir - HBV），乙肝治疗肝炎爆发的结果，阿德福韦（Hepsera），和替诺福韦（Viread）。

慢性乙型肝炎病毒（HBV）感染的人升高通常表明恶化或复发的病毒复制活跃和增加病毒的免疫反应。升高
通常是有害的，但他们有时可能会导致持续HBV和缓解病情的免疫控制，研究人员指出，作为背景。由于免疫系统攻击乙肝病毒在肝细胞（肝细胞），损坏或死亡的细胞释放丙氨酸转氨酶（ALT）。突发性ALT升高的信号可能清除病毒或导致进一步的肝损害的炎症反应。

目前的分析，包括227例，收到了351课程的核苷/核苷酸类似物治疗慢性乙型肝炎的总（即是，有些人不止一次地对待）。

结果

    核苷/核苷酸类似物治疗149个疗程（其他病人仍持续治疗）后停止。
    共有27个升高过程中观察9779个月观察病人治疗时，估计每100人年的频率为3.2。
    拉米夫定治疗的人最有可能的经验，对治疗肝升高（4.9每100人年）。
    20 27，而在接受治疗（74％）与耐药性的发展都在服用拉米夫定的患者，发生的耀斑。
    与会者经历了17升高以下149核苷/核苷酸停药（11％），停药后发生的中位数3.5个月。
    51改用其他抗病毒药物的参与者之间没有升高。
    没有停止核苷/核苷酸类似物治疗期间或之后发生的升高与持续的病毒清除或缓解病情。
    7例升高与肝功能衰竭失代偿。

基于这些发现，研究人员得出结论，“在这项研究中，相关的耀斑[核苷/核苷酸类似物治疗兵败如山倒，免疫控制和持续缓解病情，而且有时会造成失代偿性肝病。”

调查背景：胃肠病学和肝病的流行病学和生物统计学，伊拉斯谟的MC大学医学中心的鹿特丹，鹿特丹，荷兰部署;胃肠病学和肝病学系，中山医院，复旦大学，上海，中国。

11年9月13日

参考

NP张JGP ​​Reijnders，M Perquin，等。核苷（酸）IDE模拟治疗病毒性肝炎18（7）慢性乙型肝炎患者的相关升高的频率和临床结果：e252 - e257（摘要）。 2011年7月。

扎西德雷

火星文

非东亚病夫

垃圾文，只要有关于中国的科研永远都是看不懂的。