替诺福韦单药和tenofovir与恩替卡韦联合救援恩替卡韦治疗部

StephenW

替诺福韦单药和tenofovir与恩替卡韦联合救援恩替卡韦治疗部分应答
Tenofovir Monotherapy and Tenofovir Plus Entecavir Combination as Rescue Therapy for Entecavir Partial Responders; Yip B, Chaung K, Wong CR, Trinh HN, Nguyen HA, Ahmed A, Cheung R, Nguyen MH; Digestive Diseases and Sciences (Sep 2012)

   
BACKGROUND AND AIMS: Despite high potency, a significant proportion of patients treated with entecavir achieve only partial viral suppression. Our goal was to examine the complete viral suppression rate (undetectable HBV DNA PCR levels) with alternative therapies in such patients.
METHODS: We retrospectively studied 42 consecutive patients with partial response to entecavir (detectable HBV DNA at ≥12 months of therapy) who were treated at three clinics with rescue therapies: entecavir + adefovir (n = 5), tenofovir (n = 6), and entecavir + tenofovir (n = 31). Antiviral resistance was excluded by negative mutation analysis and/or absence of virologic breakthrough (increase >1 log(10)IU/mL from nadir).
RESULTS: All patients were Asian and 57 % were male with a median age of 36 (22-64) years. Only a few patients had prior exposure to lamivudine (7 %) or adefovir (7 %). Almost all patients (95 %) had positive HBeAg. Overall, the complete viral suppression rate was 79 %, and the alanine aminotransferase normalization rate was 83 % in entecavir partial responders after 6 months on rescue therapies. Cumulative complete viral suppression rates were significantly different (P = 0.0164) among the entecavir + adefovir, tenofovir, and entecavir + tenofovir treatment groups at 6 months (20 vs. 83 vs. 83 %, respectively) and 12 months (20 vs. 100 vs. 97 %). All three patients without complete viral suppression on entecavir + adefovir became aviremic 6 months after switching to entecavir + tenofovir.
CONCLUSIONS: Virologic response to entecavir + tenofovir combination therapy and tenofovir monotherapy appeared to be similar in most patients, but not with the entecavir + adefovir combination.

StephenW

背景与目的：尽管高浓度，用恩替卡韦治疗的患者的一个显着比例的实现只是局部的病毒抑制。我们的目标是检验完整的病毒抑制率（PCR检测不到HBV DNA水平），在这些患者的替代疗法。
方法：我们回顾性研究了42例部分缓解恩替卡韦（检测到HBV DNA≥12个月的治疗）三家诊所接受治疗的救援治疗：恩替卡韦+阿德福韦酯组（n = 5），替诺福韦组（n = 6），和恩替卡韦+替诺福韦组（n = 31）。抗病毒药物耐药性被排除负突变分析和/或不存在的病毒学突破（增加> 1 IU / mL的日志（10）从最低点）。
结果：所有患者是亚洲人，57％为男性，中位年龄36（22-64岁）。只有少数患者之前曾经接触拉米夫定（7％）或阿德福韦（7％）。几乎所有的患者（95％），HBeAg阳性。总体而言，完整的病毒抑制率分别为79％，恩替卡韦部分反应中的谷丙转氨酶复常率分别为83％，6个月后的抢救治疗。累计完成病毒的抑制率有显着性差异（P = 0.0164）之间的恩替卡韦+阿德福韦，替诺福韦和恩替卡韦+替诺福韦治疗组（20％和83％比83％），分别在6个月和12个月（20％和100比97％）。三名病人没有完整的病毒抑制恩替卡韦+阿德福韦成为aviremic 6个月后，改用恩替卡韦+替诺福韦。
结论：恩替卡韦的病毒学应答+替诺福韦联合治疗出现和替诺福韦单药治疗，大多数患者是相似的，但不是与恩替卡韦+阿德福韦组合。

咬牙硬挺

怕耐药

lyq2003526

对于使用恩替卡韦 只有部分病毒学应答的人，换治疗方案（共42例）-----
                                                     恩替+ 阿德,         单 替诺福韦,         恩替卡韦+替诺
                                                         6例                    5例                        31例
6个月治疗，完全的病毒抑制率：             20%                   83%                      83 %,
12个治疗， 完全的病毒抑制率：             20 %                 100%                     97 %

恩替卡韦部分应答的人，似乎转替诺福韦治疗，能更快使dna阴转。