阿德福韦治疗拉米夫定耐药的最终结果和第6个月DNA载量相关

肝胆速递

Viral response at 6 months is associated with treatment outcome of adefovir add-on therapy for lamivudine-resistance
阿德福韦治疗拉米夫定耐药的最终结果和治疗后第6个月HBV的DNA载量相关

肝胆速递：阿德福韦治疗拉米夫定耐药的最终结果和初始及治疗后第6个月的HBV的DNA载量相关

Journal of Gastroenterology and Hepatology  Vol 27 Issue 9

Viral response at 6 months is associated with treatment outcome of adefovir add-on therapy for lamivudine-resistance

    Yu Jin Kim,
    Seung Woon Paik*,
    Dong Hyun Sinn,
    Geum-Youn Gwak,
    Moon Seok Choi,
    Joon Hyeok Lee,
    Kwang Cheol Koh,
    Byung Chul Yoo

Article first published online: 21 AUG 2012

DOI: 10.1111/j.1440-1746.2011.07050.x

     Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea

*Professor Seung Woon Paik, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. E-mail: [email protected]


Abstract

Background and Aim:  Adefovir add-on therapy is recommended for patients infected with lamivudine-resistant hepatitis B virus (HBV). We aimed to describe the long-term treatment outcome and predictors for good response of adefovir add-on therapy.

Methods:  A total of 559 chronic hepatitis B (CHB) patients who had been treated for at least 12 months with adefovir add-on therapy due to resistance to lamivudine were retrospectively included. Complete virologic response (CVR) was defined as serum HBV DNA < 9 IU/mL. Viral responses at 6 months were classified as PCR negativity, partial virologic response (PVR, HBV DNA < 2000 IU/mL), or inadequate virologic response (IVR, HBV DNA ≥ 2000 IU/mL).

Results:  The median duration of follow-up was 31.5 months (range, 12–56). The cumulative probabilities of CVR during adefovir add-on therapy were 58%, 70%, 78%, and 80% at 12, 24, 36, and 43 months, respectively. The cumulative rates of resistance to adefovir were 0.4%, 0.8%, and 3.1% at 12, 24, and 36 months, respectively. The only baseline factor associated with CVR (hazard ratio 0.83, 95% confidence interval 0.62–0.91, P ≤ 0.001) and resistance to adefovir (hazard ratio 1.925, 95% confidence interval 1.13–3.30, P = 0.017) was serum HBV DNA level. Comparison of the cumulative rates of CVR and resistance to adefovir according to viral response at 6 months showed significant differences among the three groups (P < 0.0001 and P = 0.0005, respectively).

Conclusions:  Pre-treatment HBV DNA level and viral response at 6 months is associated with treatment outcome for adefovir-add on therapy in lamivudine resistance.

肝胆速递

胃肠病学和肝病学杂志第27卷第9期

在6个月与治疗结果阿德福韦酯治疗拉米夫定耐药的病毒反应

    余金社长，
    承焕白南准*
    东铉新芬，
    今妍郭氏，
    月球锡财，
    李俊赫，
    光澈岛，
    秉哲柳

在网上公布：2012年8月21日

DOI：10.1111/j.1440-1746.2011.07050.x

     医学系，韩国成均馆大学医学院，韩国首尔三星医疗中心

承焕教授白，50逸院洞，江南区，首尔135-710，韩国。电子邮件：sw.paik @ samsung.com


抽象

背景和目的：阿德福韦治疗拉米夫定耐药的乙肝病毒（HBV）感染的患者推荐。我们的目的是描述阿德福韦酯添加治疗的反应良好，长期治疗的结果和预测。

方法：将559例慢性乙型肝炎（CHB）患者经治疗后已至少12个月，阿德福韦酯治疗，由于对拉米夫定的耐药进行回顾性。完整的病毒学应答（CVR）被定义为血清HBV DNA <9 IU /毫升。在6个月被列为PCR阴性，部分病毒学应答（PVR，HBV DNA <2000 IU /毫升），或不足病毒学应答（IVR，HBV DNA≥2000 IU /毫升）病毒反应。

结果：随访时间中位数为31.5个月（范围12-56个月）。 CVR在阿德福韦酯的累积概率的附加治疗分别为58％，70％，78％和80％，在12，24，36，和43个月，分别。耐阿德福韦的累积率分别为0.4％，0.8％和3.1％，在12，24，和36个月。唯一的基线因素CVR（危险比为0.83，95％可信区间0.62-0.91，P≤0.001）和耐阿德福韦酯（危险比为1.925，95％可信区间1.13-3.30，P = 0.017）与血清HBV DNA水平。 CVR和电阻率的累计阿德福韦根据病毒的响应在6个月的比较结果显示，三组的显着差异（P <0.0001和P = 0.0005）。

结论：治疗前HBV DNA水平和病毒的响应在6个月与阿德福韦治疗拉米夫定耐药的治疗效果。