Response to tenofovir monotherapy in chronic hepatitis B patients with prior sub

StephenW

http://www.ncbi.nlm.nih.gov/pubmed/22329376
J Viral Hepat. 2012 Mar;19(3):213-9. doi: 10.1111/j.1365-2893.2011.01533.x. Epub  2011 Oct 17.
Response to tenofovir monotherapy in chronic hepatitis B patients with prior suboptimal response to entecavir.Pan CQ, Hu KQ, Yu AS, Chen W, Bunchorntavakul C, Reddy KR.
Source
Division of Liver Diseases, Department of Medicine, The Mount Sinai Medical Center, Mount Sinai School of Medicine, NY, USA
University of California, Irvine Medical Center, Orange County, CA, USA
Pacific Gastroenterology and Endoscopy, San Jose, Santa Clara County, CA, USA             Newark Beth Israel Medical Center, Newark, NJ, USA
Rajavithi Hospital, Rangsit University, Bangkok, Thailand
University of Pennsylvania, Philadelphia, PA, USA.

Abstract
Summary.  Both entecavir (ETV) and tenofovir (TDF) are potent antiviral agents for hepatitis B virus (HBV). Suboptimal response (SOR) following antiviral therapy is associated with an increased risk of subsequent treatment failure and viral resistance. It remains unclear whether switching to TDF is a reasonable approach in patients with SOR to ETV treatment. This study was aimed to determine how HBV patients with SOR to ETV respond to TDF monotherapy. Data of patients with SOR to ETV (failure to achieve >1 log(10)  HBV-DNA reduction during the last 24 weeks of ETV treatment) who were switched to TDF monotherapy during 2005 and 2010 were reviewed. Treatment adherence was assessed by pill-count. Fourteen patients (2.9%) were identified from a total cohort of 482 ETV-treated patients. All 14 patients were Chinese and were infected with HBV genotype C (71%) or B (29%). Nine patients were men, and the median age was 41.5 years (19-64). Twelve were treatment naïve (one lamivudine- and one peginterferon-experienced patient); 85.7% were HBeAg positive. The median baseline HBV-DNA was 7.55 (5.30-9.40) log(10)  copies/mL, and 57% had abnormal serum alanine aminotransferase (ALT) levels. Precore and/or basal core promoter mutations were detected in four patients, whereas no genotypic resistance was detected at baseline and before switching to TDF. The median duration of ETV treatment was 64.5 (26-126) weeks. The median HBV-DNA at the time of switching to TDF was 3.69 (3.00-4.90) log(10)  copies/mL. The median HBV-DNA reduction from baseline and during the last 6-month observation period prior to switching to TDF was 4.04 (0.51-6.06) log(10)  and 0.43 (-0.09-1.13) log(10)  copies/mL, respectively. After the switching to TDF, all 14 patients (100%) achieved undetectable HBV-DNA and ALT normalization within a median duration of 30 weeks. In 12 patients who were HBeAg positive, HBeAg seroconversion was observed in two patients after TDF treatment of 75- and 84-weeks duration. There was no virological breakthrough observed after switching to TDF with a median follow-up period of 50 (24-160) weeks. TDF treatment was safe and well tolerated. In conclusion, suboptimal response to ETV is rare (approximately 3%). TDF monotherapy is safe and very effective in the management of HBV patients with SOR to ETV.




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StephenW

J病毒Hepat。 2012 03 19（3）:213-9。 DOI：10.1111/j.1365-2893.2011.01533.x。 10月17日出处2011。
泰诺福韦在事先反应欠佳恩替卡韦治疗慢性乙型肝炎患者的单药治疗的反应。
泛CQ，胡锦涛克勤，玉的AS，陈文，BunchorntavakulÇ，雷迪雷克南。
源

科肝病，医学系，西奈山医学中心，西奈山医学院，纽约，美国加州大学欧文分校医学中心，奥兰治县，加州，美国太平洋胃肠病学和内窥镜，圣何塞，圣克拉拉县， CA，美国纽瓦克贝斯以色列医学中心，纽瓦克，新泽西州，美国Rajavithi医院，兰实大学，曼谷，泰国，美国宾夕法尼亚大学，费城宾夕法尼亚，美国。

摘要。都替卡韦（ETV）和替诺福韦（TDF）是B型肝炎病毒（HBV）的强效的抗病毒药物。最理想的响应（SOR）抗病毒药物治疗后与后续治疗失败和病毒抗性的风险增加。目前还不清楚是否切换到TDF的是合理的做法在长远发展策略，以教育电视治疗患者。这项研究的目的是确定如何与长远HBV患者ETV回应TDF的单一。患者的SOR ETV（未能达到> 1log（10）HBV  -  DNA减少，在过去的24周治疗ETV）谁是在2005年和2010年切换到TDF的单一的数据进行了审查。坚持治疗评估丸计数。 14例（2.9％），确定了从482 ETV治疗的患者的总队列。中国所有14例患者和感染HBV C基因型（71％）或B（29％）。 9例患者为男性，平均年龄为41.5岁（19-64岁）。十二个​​天真的治疗（拉米夫定和一个经验丰富的聚​​乙二醇病人）; 85.7％，HBeAg阳性。基线HBV-DNA的中位数为7.55（5.30-9.40）log（10）拷贝/毫升，57％有异常的血清谷丙转氨酶（ALT）水平。前C区和/或基本核心启动子突变检出4例，而没有在基线和切换到TDF的前检测基因型耐药。治疗ETV的时间平均为64.5（26-126）周。在切换到TDF的时间，HBV-DNA中位数为3.69（3.00-4.90）log（10）拷贝/ ml。 HBV-DNA的中位数从基线和减少在过去6个月的观察期前切换到TDF的是4.04（0.51-6.06）log（10）和0.43（-0.09-1.13）log（10）拷贝/毫升，分别。 TDF的开关后，所有14例患者（100％）中位数为30周时间内检测不到HBV-DNA和ALT正常化。在12例HBeAg阳性，HBeAg血清转换后两名患者在TDF的治疗，75  -  84周时间。有没有病毒学突破后，中位随访50（24-160）周期间切换到TDF的观察。 TDF的治疗是安全的，耐受性良好。总之，ETV是最理想的反应罕见（约3％）。 TDF的单药治疗是安全的和非常有效的乙肝患者的管理与长远发展策略，以ETV。

咬牙硬挺

希望有更好的药物，其实乙人应该感谢艾滋病毒

把握当下

StephenW 发表于 2012-2-24 06:05
http://www.ncbi.nlm.nih.gov/pubmed/22329376
J Viral Hepat. 2012 Mar;19(3):213-9. doi: 10.1111/j.1365 ...

使用恩替效果不佳换单独替诺效果研究

摘要
总结。恩替、替诺都是治疗乙肝的强效药。治疗效果不佳（SOR）会导致后续治疗失败、耐药风险增加。目前是否应该为对使用恩替效果不佳患者换替诺还不清楚。本文研究恩替效果不佳乙肝患者对替诺单药治疗的相应情况。

研究对象包括：2005-2010年期间，出现恩替SOR（6个月恩替dna下降不超过1次方）换替诺单药治疗的患者。治疗依从性通过药片计数衡量（Treatment adherence was assessed by pill-count）。其中9人男性，平均年龄41.5岁 (19-64)。12人是初治（1人有拉米治疗史，1人有干扰治疗史）；85.7%患者为e抗原阳性。HBV-DNA平均基线7.55 (5.30-9.40) log(10) copies/mL，57%患者ALT正常。4名患者检测出前c区和/或基本c区变异，换替诺之前都没有检测出耐药（whereas no genotypic resistance was detected at baseline and before switching to TDF）。恩替平均治疗期为64.5 (26-126)周。换单替诺时HBV-DNA平均基线是3.69 (3.00-4.90) log(10)  copies/mL。

HBV-DNA从基线开始的下降幅度是 4.04 (0.51-6.06) log(10) ，换替诺之前6个月HBV-DNA下降幅度为0.43 (-0.09-1.13) log(10)  copies/mL。换替诺之后共计14名患者(100%)HBV-DNA低于最低检测线，平均30周后ALT正常。12名e抗原阳性患者中，2人在换替诺后75- 84周获得e抗原血清转换。换替诺之后在平均50 (24-160)周随访期内没有发生病毒学反弹。替诺治疗是安全并且易于患者耐受的。

结论：恩替效果不佳较少(大概3%)。恩替SOR换TDF单药安全有效。