在现实实践中恩替联合阿德抢救治疗经过多次治疗失败的慢

StephenW

Entecavir plus adefovir rescue therapy for chronic hepatitis B patients after multiple treatment failures in real-life practice


AimTo evaluate the efficacy and safety of Entecavir (ETV) plus adefovir (ADV) for chronic hepatitis B (CHB) patients after multiple nucleos(t)ide analogue (NAs) failure treatment.

Methods: Hepatitis B e antigen (HBeAg)-positive patients who had a suboptimal response or developed resistance to two or more previous NAs treatments were included, and all subjects were treated with ETV in combination with ADV for >= 24 months. Complete virologic response (CVR) was defined as an undetectability of serum hepatitis B virus (HBV) DNA level during treatment.

Safety assessment was based on the increasing of serum creatinine and creatine kinase levels.

Results: A total of 45 eligible patients were included. Twenty-five patients had been treated with lamivudine (LAM) or telbivudine (LdT) and developed genotypic resistance.

Resistance to ADV was present in 18 patients and 4 patients had a suboptimal response to ETV. Two patients had a resistance to both LAM and ADV.

The cumulative probabilities of CVR at 12 and 24 months of ETV + ADV treatment were 88.9% (40/45) and 97.8% (44/45), respectively. Although one patient failed to achieve CVR, its serum HBV DNA level decreased by 3.3 log copies/mL after 24 months of combination therapy.

The cumulative probability of HBeAg seroconversion was 15.6% (7/45) and 26.7% (12/45) at 12 and 24 months of treatment, respectively. History of prior exposure to specific NAs did not make a difference to ETV + ADV treatment outcome.

There were no significant adverse events related to ETV + ADV therapy observed in the studysubjects.

Conclusion: ETV + ADV can be used as an effective and safe rescue therapy in patients after multiple NA therapy failures, especially in the areas where tenofovir is not yet available.

Author: Xian-Hua XuGai-Li LiYang QinQiang LiFa-Qun HeJin-Ye LiQuan-Rong PanJie-Yin Deng
Credits/Source: Virology Journal 2013, 10:162

StephenW

AimTo评价恩替卡韦（ETV）加上阿德福韦（ADV）的疗效和安全性慢性乙型肝炎（CHB）患者（T）后，多个核苷类似物（NAS）故障处理。

方法：乙型肝炎e抗原（HBeAg）阳性的患者有反应欠佳，或开发耐两个或多个先前的NAS治疗都包括在内，所有受试者接受恩替卡韦结合ADV> = 24个月。被定义为不可检测血清乙型肝炎病毒（HBV）DNA水平在治疗过程中的完整的病毒学应答（CVR）。

安全性评估的基础上的增加，血清肌酐和肌酸激酶水平。

结果：总共有45个符合条件的患者都包括在内。二十五名患者治疗与拉米夫定（LAM），替比夫定（LDT）和基因型耐药。

抗ADV 18例，4例ETV反应欠佳。两名患者进行了抗LAM和ADV。

ETV + ADV治疗12个月和24个月的CVR的累积概率分别为88.9％（40/45）和97.8％（44/45），分别。虽然一位患者未能实现CVR，其血清HBV DNA水平下降了3.3日志拷贝/ ml，24个月后的联合治疗。

的累积概率为15.6％（7/45）和26.7％（12/45），分别在12和24个月的治疗，HBeAg血清学转换。特定NAS之前曝光的历史并没有使ETV + ADV治疗结果的差异。

目前还没有显着的不良事件相关ETV + ADV治疗在studysubjects观察。

结论：ETV + ADV可以用来作为一种安全有效的多个NA疗法失败后的患者的抢救治疗，尤其是在地方替诺福韦尚未提供。