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本帖最后由 StephenW 于 2013-1-7 13:56 编辑
回复 悟天 的帖子
谢谢。我错了. 小部分患者用NUCs失去了乙肝表面抗原可能反弹.在这方面AASLD2012的最新研究:
| TITLE: Is HBsAg Seroclearance Following Nucleoside Analogue Therapy Durable in Patients with Chronic Hepatitis B? | | AUTHORS (FIRST NAME, LAST NAME): Gi Ae Kim1, Young-Suk Lim2, Jihyun An2, Danbi Lee2, Ju Hyun Shim2, Kang Mo Kim2, Han Chu Lee2, Young-Hwa Chung2, Yung Sang Lee2, Dong Jin . Suh2 | | Institutional Author(s): | INSTITUTIONS (ALL): 1. Department of Internal Medicine, Asan Medical Center, Seoul, Korea, Republic of.
2. Department of Gastroenterology, Asan Medical Center, Seoul, Korea, Republic of.
| | ABSTRACT BODY: Background: Spontaneous or interferon-induced HBsAg seroclearance is durable in most patients with chronic hepatitis B (CHB). However, little is known about the durability of HBsAg seroclearance following nucleoside analogue (NUC) therapy. Methods: Among 4,578 patients who were treated with either lamivudine (n=1,924) or entecavir (n=2,654) at a tertiary referral hospital in Korea between 2000 and 2010, 121 achieved HBsAg seroclearance. Fifty-eight patients were included in this study after exclusion of 63 patients; acute hepatitis B (n=19), hepatocellular carcinoma (n=8), prior treatment with interferon (n=6), prior immunosuppressive therapy (n=17), liver transplantation (n=6), follow-up loss immediately after HBsAg seroclearance (n=5), and continued NUC therapy (n=2). Results: Mean age of 58 patients were 42 years (SD 11 years) and 41 (71%) were males. All were assumed to have HBV genotype C. At the initiation of NUC therapy, median levels of ALT and HBV DNA were 153 IU/L (interquartile range [IQR], 48-340 IU/L) and 7.0 log10 copies/mL (IQR, 3.8-8.0 log10 copies/mL), respectively. Twenty-seven (47%) had HBeAg. The median duration of NUC therapy (56 with lamivudine and 2 with entecavir) before HBsAg seroclearance was 42 months (IQR, 24-66 months). During a median follow-up period of 20 months (IQR, 12-32 months), HBsAg reversion occurred in 5 of 58 (8.6%) patients. Three of those 5 patients achieved re-clearance of HBsAg without treatment during further follow-up. The other 2 patients remained HBsAg-positive, but with low titer (< 1.0 IU/mL) and undetectable HBV DNA by PCR. Cumulative rate of anti-HBs antibody appearance was 70% at 4 years. Virologic recurrence (detectable HBV DNA by PCR) occurred in 12 of 58 (20.7%) patients. However, all of these patients maintained HBV DNA <10,000 copies/mL. No patient experienced biochemical relapse (ALT flare > x5 ULN). Conclusion: HBsAg seroclearance following NUC therapy is rare but durable in most patients with CHB after treatment discontinuation. Therefore, HBsAg seroclearance would be an ideal treatment endpoint during NUC therapy. |
慢性乙型肝炎NUC治疗乙肝表面抗原转阴是罕见的,但停止治疗后大多数患者耐久。因此，乙肝表面抗原转阴，将是一个理想的NUC治疗终点。
| TITLE: Nucleos(t)ide analogues can be safely discontinued in chronic hepatitis B patients achieving HBsAg seroclearance | | AUTHORS (FIRST NAME, LAST NAME): Federica Invernizzi1, Pietro Lampertico1, Alessandro Loglio1, Massimo Iavarone1, Mauro Viganò2, Floriana Facchetti1, Elena Vezali1, Giovanna Lunghi3, Massimo Colombo1 | | Institutional Author(s): | INSTITUTIONS (ALL): 1. 1st Division of Gastroenterology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy.
2. Liver Unit, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy.
3. Institute of Preventive Medicine, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
| ABSTRACT BODY: Background: Though chronic hepatitis B (CHB) patients achieving HBsAg seroconversion with NUCs are recommended to withdraw from therapy, still doubts exist whether this rule can be applied safely in clinical practice and in patients clearing HBsAg without seroconversion to anti-HBs. Aim: To assess the outcome of patients withdrawing from NUC therapy after HBsAg clearance. Methods: 27 out of 520 (5%) CHB patients who received NUC between 1997-2008, ultimately lost serum HBsAg and were followed for 44 (12-117) months thereafter. At the time of HBsAg clearance all patients had normal ALT, were HBeAg negative (48% HBeAg positive pre-treatment) and had undetectable HBV DNA (real time PCR < 10 IU/mL); median age was 56 years, 85% male, 52% cirrhotics, 56% genotype D, 56% CC genotype IL28B (SNP rs12979860). Eighteen (67%) patients received monotherapy (11 LAM, 3 ETV, 4 TDF) and 9 (33%) combination (5 LAM+ADV, 4 LAM+TDF); 5 (18%) were previously treated with interferon. HBsAg was quantified by Architect (Abbot Diagnostics, detection limit 0.05 IU/mL). Results: 19 (70%) patients discontinued treatment 0-41 months after HBsAg seroconversion, 7 having anti-HBs levels of 10-100 IU/mL, 6 of 100-500 IU/mL and 6 of 500->1000 IU/mL. Eight additional (30%) patients discontinued NUC therapy despite the absence of significant anti-HBs titers during a consolidation period of 27 (13-36) months, and 6 ultimately seroconverted to anti-HBs. Among the 27 patients who stopped therapy, 26 remained HBsAg seronegative during 25 (2-81) months of post-treatment follow-up, 3 (9%) showing a blip of HBV DNA ranging from 16 to 93 IU/ml without any change in anti-HBs titers, within the first 3 months off therapy. In a 49 y.o. non cirrhotic male, genotype IL28B CT, genotype D, anti-HBs negative patient, anti-HBs seroconversion was preceded by a transient reactivity for HBsAg, HBeAg and HBV DNA at month 2 off therapy.
Conclusion: Patients reaching the therapeutic end point of HBsAg clearance can be safely withdrawn from NUC following either anti-HBs seroconversion or at least 12 months of a post clearance consolidation period.
患者达到HBsAg清除治疗终点,抗-HBs血清转换后或巩固期至少12个月可以安全地停止NUC | | (No Table Selected) | | (No Image Selected) |
Co-Author Disclosure Status | | The following authors have completed their AASLD 2012 disclosure: | | Federica Invernizzi: Disclosure completed | | Pietro Lampertico: Disclosure completed | | Alessandro Loglio: Disclosure completed |
| | Mauro Viganò: Disclosure completed | | Floriana Facchetti: Disclosure completed | | Elena Vezali: Disclosure completed | | Giovanna Lunghi: Disclosure completed | | Massimo Colombo: Disclosure completed |
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楼主: yg88
发表于 2013-1-6 23:16
