oral anti-viral agents in adults with decompensated hepatitis B virus cirrhosis

StephenW

Aliment Pharmacol Ther. 2012 Jan 19. doi: 10.1111/j.1365-2036.2011.04990.x.
Source: http://www.ncbi.nlm.nih.gov/pubmed/22257108
Meta-analysis: oral anti-viral agents in adults with decompensated
hepatitis B virus cirrhosis. Singal AK, Fontana RJ.
SourceDivision of Gastroenterology, Department of Internal medicine,
University of TX Medical Branch, Galveston, TX, USA. Abstract
BACKGROUND: The optimal oral anti-viral agent to use in patients with
decompensated HBV cirrhosis remains unclear. AIM: We performed a
meta-analysis of the oral nucleos(t)ide analogues in patients with
decompensated HBV cirrhosis. METHODS: One year efficacy and safety outcomes
in 22 studies published in English between95 and 2010 were analysed.
RESULTS: Substantial heterogeneity was noted in the inclusion/exclusion
criteria, controls, and sensitivity of the HBV DNA assay used. Pooled
1-year data showed benefit favouring lamivudine (LAM) vs. untreated
controls for Child-Turcotte-Pugh (CTP) score improvement by ?2 (OR: 117 (15
921), P ? 0.0001) and transplant-free survival (OR: 3.2 (1.2, 9), P =
0.022). Adefovir (ADV) led to undetectable HBV DNA at 1-year in 41%
compared to 83% with LAM and 80% with entecavir (ETV). Overall, 1-year
transplant-free survival rates varied from 78% with LAM to 95% and 94% with
Tenofovir (TDF) and Telbivudine (TBV), respectively. The 1-year incidence
of drug resistant HBV was 0% with ADV, ETV and TDF and 11% with LAM
although TBV was associated with a 29% incidence at 2 years. Drug-related
adverse events were infrequently reported. CONCLUSIONS: All the oral
anti-viral agents were associated with improved virological, biochemical
and clinical parameters at 1-year. However, the efficacy of lamivudine and
telbivudine is limited by drug resistance, and adefovir is limited by its
potency and slower onset of action. Additional studies of tenofovir and
entecavir are needed to determine the optimal agent(s) for treatment naïve
patients and in those with drug-resistant decompensated HBV cirrhosis.

StephenW

Aliment药理学。 2012年1月19日。 DOI：10.1111/j.1365-2036.2011.04990.x。
资料来源：http://www.ncbi.nlm.nih.gov/pubmed/22257108
Meta分析：失代偿成人口服抗病毒药物
B型肝炎病毒肝硬化。葛AK，丰塔纳RJ。
SourceDivision消化内科，内科，
德克萨斯大学医学科，加尔维斯顿，美国德克萨斯州。摘要
背景：最佳的口服抗病毒的患者使用
失代偿期乙型肝炎肝硬化仍不清楚。目的：我们进行了一项
在与患者的口服核苷（酸）IDE类似物的Meta分析
失代偿期乙型肝炎肝硬化。方法：一年的疗效和安全性结果
between95和2010年在英国出版的22项研究进行了分析。
结果纳入/排除有人指出：大量的异质性
使用标准，控制和HBV - DNA检测的灵敏度。汇集
1年的数据显示，受益有利于拉米夫定（LAM）与未处理
控制儿童特科特- Pugh分级（CTP）的评分改善2（或：117（15
921），P？ 0.0001），移植无病生存（或：3.2（1.2），P =
0.022）。阿德福韦（ADV）LED检测不到HBV DNA的41％，1年
比林的83％和80％恩替卡韦（ETV）。总体而言，1年
移植无病生存率从78％变化与林以95％和94％
泰诺福韦（TDF）和替比夫定（TBV），分别。 1年期的发病率
抗乙肝病毒药物是0％，ADV，ETV和TDF和林的11％
虽然TBV与29％的发病率在2年。与毒品有关
不良事件很少报道。结论：所有的口服
抗病毒药物与改善病毒学，生化
在1年的临床参数。然而，拉米夫定的疗效和
替比夫定耐药性是有限的，是由它的有限和阿德福韦
效力和行动开始放缓。更多的研究和替诺福韦
恩替卡韦需要，以确定最佳治疗天真剂（S）
患者和耐药失代偿期乙型肝炎肝硬化的。