APASL2013 乙肝妇女怀孕期间停抗病毒药

StephenW

Safety of Discontinuation of Antiviral Agent during Pregnancy in Women Infected with Hepatitis B Virus  
   
Hee Yeon Kim, Jong Young Choi, Chang Wook Kim, Jeong Won Jang, Chung-Hwa Park, Si Hyun Bae, Seung Kew Yoon, Ho Jong Chun, Chang Don Lee, Young Sok Lee
The Catholic University of Korea, Seoul, Republic of Korea

Background: Women who are taking antiviral agents and become pregnant have several options that include, continuing therapy, ceasing drugs, or switching to safer drugs. However, there are limited data on the outcome in pregnant women after withdrawal of antiviral agents.
Objectives: We aimed to investigate the outcome of stopping antiviral agents in pregnant women with chronic hepatitis B virus (HBV) infection.
Study design: In this single-center, retrospective cohort study, 12 pregnant patients who had received antiviral therapy for HBV and cease drugs after awareness of pregnancy between 2002 and 2010 were enrolled. We retrospectively studied virologic and biochemical flares during pregnancy and postpartum period.
Results: Median age at pregnancy was 30.5 (range, 24─35) years, median duration of antiviral drug before pregnancy was 15.3 (range, 3.0─131.3) months, and median HBV DNA at withdrawal of therapy was 4.8 (range, 1.7─8.0) log10 copies/mL. Eight out of 12 patients (66.7%) had a viral rebound after stopping antiviral drugs during pregnancy. Severe hepatitis flares, defined as a 5-fold increase in serum alanine aminotransferase (ALT), were observed in six patients (50%) during pregnancy. However, most patients spontaneously recovered without an event of hepatic decompensation. High pretreatment ALT was associated with severe hepatitis flares after cessation of therapy during pregnancy. Five patients with at least 1-year treatment before pregnancy maintained low hepatitis activity after delivery.
Conclusions: Pregnant women with high pretreatment ALT or those treated less than one year before pregnancy have high risk of severe hepatitis flares after cessation of antiviral agents.


Assigned speakers:
Dr. Ho Jong Chun, The Catholic University of Korea , Seoul , Republic of Korea

Assigned in sessions:
07.06.2013, 08:30-17:30, PT-4, HEP B Clinical, Exhibition Hall

StephenW

背景：谁是服用抗病毒药物和怀孕的妇女有几个选项，其中包括继续治疗，停止药物，或切换到更安全的药物。不过，也有孕妇抗病毒药物停药后的结果有限的数据。
目标：我们的目的是停止抗病毒药物在慢性乙型肝炎病毒（HBV）感染的孕妇进行调查的结果。
研究设计：在这种单中心，回顾性队列研究，谁收到了乙肝抗病毒治疗，并停止药物后怀孕的意识在2002年和2010年之间的12名孕妇患者入选。我们回顾性研究病毒学和生化耀斑的孕期和产后期。
结果：怀孕时的年龄中位数为30.5（范围，24─35岁），怀孕前抗病毒药物的时间中位数为15.3（范围3.0  -  131.3）个月，并在撤出治疗HBV DNA中位数为4.8（范围，1.7─ 8.0）log10拷贝/毫升。八出12例（66.7％）在怀孕期间抗病毒药物停药后病毒反弹。重症肝炎耀斑，定义为有5倍的增加，血清谷丙转氨酶（ALT），观察在怀孕期间有6例（50％）。然而，大多数患者自发地恢复，没有发生肝功能失代偿。在怀孕期间停止治疗后伴有严重的肝炎爆发前ALT高。至少在怀孕前1年的治疗5例分娩后保持低肝炎活动。
结论：高怀孕前治疗前ALT或治疗的不到一年的孕妇有高风险的重症肝炎耀斑后停止抗病毒药剂。

咬牙硬挺

吃替诺怀孕安全性有多高啊