EASL 2013: 基线HBSAG预测HBsAg转阴 - 干扰素α-2a+阿德福韦

StephenW

Abstract 753
     
BASELINE HBSAG PREDICTS HBSAG LOSS AFTER 2 YEARS OF TREATMENT-FREE FOLLOW-UP IN CHRONIC HEPATITIS B PATIENTS TREATED WITH PEGINTERFERON ALFA-2A AND ADEFOVIR   

L. Jansen1*, R.B. Takkenberg1, A. de Niet1, H.L. Zaaijer2,3, C.J. Weegink1, V. Terpstra4, M.G.W. Dijkgraaf5, R. Molenkamp6, P.L.M. Janssen1, M. Koot7, V. Rijckborst8, H.L.A. Janssen8, M.G.H.M. Beld1, H.W. Reesink1
1Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, 2Microbiology, Academic Medical Center (AMC), 3Blood Borne Infections, Sanquin, Amsterdam, 4Pathology, Bronovo Hospital, The Hague, 5Clinical Research Unit, 6Microbiology, Academic Medical Center, University of Amsterdam, 7Virus Diagnostic Services, Sanquin, Amsterdam, 8Gastroenterology and Hepatology, Erasmus MC, University Hospital Rotterdam, Rotterdam, The Netherlands. *[email protected]

Introduction and aim: Considering the low efficacy and significant side effects of peg-IFN based therapy, there is a need to establish predictors of response to allow selection of patients likely to benefit from treatment. Therefore we determined response and predictors of response in chronic hepatitis B patients treated with peg-IFN and adefovir combination therapy.
Patients and methods: We treated 92 chronic hepatitis B patients (44 HBeAg-positive and 48 HBeAg-negative) with HBV-DNA >100,000 copies/mL (>17,182 IU/mL) with peg-IFN and adefovir for 48 weeks, and followed them up for 2 years. Markers for HBeAg loss, combined response (HBV-DNA levels ≤ 2,000 IU/mL and ALT normalization), and HBsAg loss were evaluated. Serum HBsAg quantitation was performed by the Abbott Architect. Predictors of response were examined by logistic regression analysis.
Results: After 2 years of treatment free follow up, rates of HBeAg loss and HBsAg loss in HBeAg-positive patients were 18/44 (41%) and 5/44 (11%), respectively. Four of them developed anti-HBs. In HBeAg-negative patients, rates of combined response and HBsAg loss were 12/48 (25%) and 8/48 (17%), respectively. All but one HBeAg-negative patient with HBsAg loss had developed anti-HBs at 2 years of follow up. In HBeAg-positive patients no baseline markers predicted HBeAg- or HBsAg loss. HBeAg-negative patients with HBsAg loss had significantly lower baseline HBsAg levels than those without HBsAg loss (mean HBsAg 2.35 versus 3.55 log IU/mL, p < 0.001). They also had lower HBV-DNA levels and were more often (peg-) interferon experienced. Baseline HBsAg was the only independent predictor of HBsAg loss (OR 0.02, p = 0.01).
Conclusions: With combination therapy of peg-IFN and adefovir for 48 weeks, a high rate of HBsAg loss was observed in both HBeAg-positive (11%) and HBeAg-negative (17%) patients two years after end of treatment. In HBeAg-negative patients, a low baseline HBsAg level was a strong predictor for HBsAg loss.


Assigned speakers:
Mr. Louis Jansen, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands

Assigned in sessions:
26.04.2013, 09:00-18:00, Poster Session, P02-07c, Category 07c: Viral Hepatitis B & D: Clinical (therapy, new compounds, resistance), Poster Area

StephenW

简介及宗旨：考虑到低PEG-干扰素为基础的治疗的疗效和显着的副作用，有必要建立响应的预测可能从治疗中获益的患者，让选择。因此，我们决定响应和预测PEG-干扰素和阿德福韦酯联合治疗慢性乙型肝炎患者的反应。
患者和方法：我们收治了92例慢性乙肝患者（44例HBeAg阳性和HBeAg阴性48）与HBV-DNA> 100,000拷贝/ ml（> 17,182 IU / mL）的PEG-干扰素和阿德福韦48周，并遵循随访2年。 HBeAg消失，加之响应（HBV-DNA水平≤2,000 IU / mL和ALT正常化），HBsAg消失的标记进行了评价。雅培Architect进行血清HBsAg定量。 logistic回归分析研究预测响应。
结果：经过2年的免费治疗跟进，HBeAg阳性患者HBeAg转阴，HBsAg消失率分别为18/44（41％）和5/44（11％），分别为。其中的四个开发抗-HBs。在HBeAg阴性患者，联合应答和HBsAg消失率分别为12/48（25％），8/48（17％），分别为。所有，但HBeAg阴性患者HBsAg消失已开发出抗-HBs在2年的随访。在HBeAg阳性患者没有基线标记预测大三阳或HBsAg消失。 HBeAg阴性患者的HBsAg消失有显着较低的基线HBsAg水平比那些不HBsAg消失（指乙肝表面抗原2.35与3.55日志IU / mL时，P <0.001）。他们也有较低的HBV-DNA水平，，且常（PEG）干扰素经历。基线乙肝表面抗原HBsAg消失（OR 0.02，P = 0.01）是唯一的独立预测因素。
结论：PEG-干扰素和阿德福韦联合治疗48周，观察HBsAg消失率很高（11％）HBeAg阳性和HBeAg阴性患者（17％），治疗结束后的两年。在HBeAg阴性患者中，低基线HBsAg的水平是一个强有力的预测HBsAg消失。