聚乙二醇干扰素单用或联合核苷(酸)类似物治疗慢性乙型肝炎

StephenW

2012年第6期《中华肝脏病杂志》
李茂英等荟萃分析了聚乙二醇干扰素单用或联合核苷(酸)类似物治疗慢性乙型肝炎的疗效与安全性，发现联合治疗可提高慢性乙型肝炎患者生物化学应答率及病毒学应答率，且联合治疗组的HBeAg阴转率高于单药治疗组(李茂英等，第442～447页)
Zhonghua Gan Zang Bing Za Zhi. <http://www.ncbi.nlm.nih.gov/pubmed/&gt; 2012 Jun;20(6):442-7. doi: 10.3760/cma.j.issn.1007-3418.2012.06.013.

[Comparison of peg-interferon monotherapy to peg-interferon and nucleos(t)ide analogue combination therapy for hepatitis B: a meta- analysis of randomized controlled trails].

[Article in Chinese]

Li MY
Yuan XL
Zhang DZ


Source

Department of Infectious Diseases, the Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China.

Abstract

To evaluate the efficacy and safety of pegylated-interferon (Peg-IFN) treatment as monotherapy or in combination with nucleos(t)ide analogues (NAs) for treating chronic hepatis B (CHB) infection.Searches of PubMed, OVID, EMBASE, and the Chinese Medical (WanFang, CNKI, and VIP) databases were conducted to identify all relevant randomized controlled trials published since Janurary 1990. Twelve studies comparing Peg-IFN monotherapy to NA combination therapy (lamivudine (LAM), n =8); adefovir (ADV), n = 4) met the inclusion criteria (treatment duration, range: 48-52 weeks; follow-up, range: 24 weeks to three years). Meta-analysis was performed with RevMan 5.0 using the fixed-effects and random-effects models. Patients who had received combination therapy had a higher biochemical response rate at the end of treatment than those who had received monotherapy (51.1% vs. 38.9%, odds ratio (OR) = 1.63, 95% confidence interval (CI): 1.33-2.01, P less than 0.01). Subgroup analysis of Peg-IFN combination therapies with LAM or ADV indicated that neither NA type significantly enhanced the increased efficacy of combination therapy compared to monotherapy. The combination therapy subgroups also had higher virologic response rates at the end of treatment than the monotherapy subgroups (LAM: 65.9% vs. 34.9%, OR = 3.57, 95% CI: 1.83-6.95, P less than 0.01; ADV: 74.6% vs. 46.2%, OR = 3.66, 95% CI: 2.13-6.30, P less than 0.01). Moreover, the combination therapy group had a higher sustained biochemical response rate at the end of follow-up than the monotherapy group (47.6% vs. 42.1%, OR = 1.28, 95% CI: 1.05-1.55, P less than 0.05). The LAM combination therapy subgroup had a significantly higher biochemical response rate than the monotherapy subgroup, but there was no significant difference between the LAM and ADV combination therapy subgroups. At the end of follow-up, the ADV combination therapy subgroup had a signficantly lower rate of hepatitis B e antigen (HBeAg) than the monotherapy subgroup, but there was no significant difference between the ADV and LAM combination therapy subgroups for HbeAg reduction. The combination therapy group and monotherapy group showed no statistically significant differences in HBsAg reduction or occurrence of severe adverse events. Peg-IFN/NA combination therapy produces a higher biochemical response rate in CHB patients than PEG-IFN monotherapy. Moreover, Peg-IFN/ADV combination therapy produces a greater reduction in HBeAg than Peg-IFN monothera

StephenW

为了评估的有效性和安全性的聚乙二醇化干扰素（PEG-IFN）治疗，单药或联合核苷（酸）类似物治疗慢性肝B（CHB）infection.Searches的的的PubMed，OVID，EMBASE（NAS），中国医学数据库（万方，CNKI，VIP）进行，以确定所有相关的随机对照试验，1990年自明年一月公布。 12项研究，比较PEG-IFN单药治疗NA联合治疗组（拉米夫定（LAM），N = 8），阿德福韦酯（ADV），N = 4）符合纳入标准（治疗时间，范围：48-52周的后续行动，范围：24周〜3年）。应用Revman 5.0使用固定效应和随机效应模型进行Meta分析。联合治疗的患者有较高的生化反应率比那些谁收到单药治疗（分别为51.1％和38.9％，在治疗结束后的比值比（OR）= 1.63，95％可信区间（CI）：1.33-2.01 ，P小于0.01）。 LAM或ADV PEG-IFN联合疗法的亚组分析显示，无论是NA型相比，单药治疗，联合治疗显着提高了疗效增加。结合治疗亚组在治疗结束后也有较高的病毒学应答率比单药治疗亚组（LAM：65.9％比34.9％，OR = 3.57，95％CI：1.83-6.95，P小于0.01; ADV：74.6％和46.2％，OR = 3.66，95％CI：2.13-6.30，P小于0.01）。此外，联合治疗组有较高的持续的生化反应率在年底的后续比单药组（47.6％比42.1％，OR = 1.28，95％CI：1.05-1.55，P小于0.05）。林联合治疗亚组有显着较高的生化反应率比单药治疗亚组，，但LAM和ADV联合治疗亚组之间没有显着差异。在年底跟进，ADV联合治疗亚组有一个signficantly的速率比单药治疗亚组的B型肝炎e抗原（HBeAg），但并没有显着的区别ADV和LAM联合治疗亚组对于HBeAg减少。联合治疗组和单药治疗组显示乙肝表面抗原减少，或出现严重不良事件无统计学显着差异。 Peg-IFN/NA联合治疗产生了更高的生化反应速度比PEG-IFN单药治疗慢性乙型肝炎患者。此外，Peg-IFN/ADV联合治疗产生较大的减速比的PEG-IFN monotherapy在HBeAg

咬牙硬挺

联合治疗当时效果显著，停药之后呢？能维持的住吗

寻水的鱼

联合老贵了