停止治疗e抗原阴性患者恩替卡韦治疗响应的耐久性

StephenW

Off therapy durability of response to Entecavir therapy in hepatitis B e antigen negative chronic hepatitis B patients
June 7, 7:28 AM
Wen-Juei Jeng, I-Shyan Sheen, Yi-Cheng Chen, Chao-Wei Hsu, Rong-Nan Chien, Chia-Ming Chu, Yun-Fan Liaw

Abstract

The optimal duration of nucelos(t)ide analoge (Nuc) treatment in hepatitis B e antigen (HBeAg) negative patients with chronic hepatitis B virus (HBV) infection is unknown. Asian Pacific Association for the Study of the Liver (APASL) guidelines recommend that treatment can be discontinued if undetectable HBV-DNA has been documented on three occasions ≥ 6 months apart. This study aimed to test this stopping rule in HBeAg-negative chronic hepatitis B (CHB) patients treated with Entecavir (ETV). Ninety-five patients (39 cirrhotics) were treated with ETV for a median of 721 (395-1762) days before stopping therapy and were then monitored with serum HBV DNA and alanine aminotransferase (ALT) at least every 3 months. Within 1-year after stopping ETV therapy, “clinical relapse” (an episode of ALT elevation >2× upper limit of normal plus HBV-DNA>2000IU/mL) occurred in 43 (45.3%) of the 95 patients. Of the 39 cirrhotic patients, 17 (43.6%) relapsed and one (2.6%) developed decompensation. The median duration till relapse was 230 days (74.4% > 6 months). Logistic regression analysis showed that baseline HBV-DNA ≤2×105 IU/mL was the only significant independent factor for sustained response. The 1-year relapse rate was 29% in patients with a baseline HBV DNA ≤2×105 IU/mL vs 53% in those with HBV DNA >2×105 IU/mL (p=0.027). For the later, consolidation therapy > 64 weeks reduced relapse rate to 33.3% in non-cirrhotic patients. Conclusion: With an overall 1-year relapse rate of 45% and 29% in those with a baseline serum HBV DNA ≤2×105 IU/mL, the APASL stopping rule for HBeAg-negative CHB patients with proper off-therapy monitoring is adequate even in cirrhotic patients. Consolidation therapy > 64 weeks seems more appropriate for those with higher baseline HBV DNA. (HEPATOLOGY 2013.)

StephenW

最佳核苷/核苷酸治疗乙肝e抗原（HBeAg）阴性患者的时间是未知的。亚洲太平洋研究协会肝病（APASL）指南建议，如果检测不到HBV-DNA已被记录三次间隔≥6个月，治疗可以停药。本研究旨在测试此停止统治HBeAg阴性慢性乙型肝炎（CHB）患者使用恩替卡韦（ETV）。中位数为721（395-1762）日前停止治疗，92名患者（39例肝硬化患者），恩替卡韦治疗，血清HBV DNA和丙氨酸转氨酶（ALT），至少每3个月监测。在1年后停止ETV治疗发生在95例患者中有43例（45.3％），“临床复发”（一个小插曲ALT升高> 2×正常值上限的加HBV-DNA> 2000IU/mL）。 39例肝硬化，17例（43.6％）复发（2.6％），失代偿。直到复发的中位时间为230天（74.4％> 6个月）。 Logistic回归分析显示，基线HBV-DNA≤2×105 IU / mL的持续应答的唯一显着的独立危险因素。 1年无复发率为29％患者的基线HBV DNA≤2×105 IU /毫升与53％，HBV DNA> 2×105 IU /毫升（P = 0.027）。 > 64周后，巩固治疗复发率降低至33.3％，在非肝硬化患者。结论：随着整体的1年复发率45％和29％在基线血清HBV DNA≤2×105 IU / mL的，适当的治疗监测HBeAg阴性CHB患者的APASL停止规则是足够的即使是在肝硬化患者。巩固治疗> 64周似乎更适合于那些具有较高的基线HBV DNA。 （肝胆病2013年。）

StephenW

这项研究是非常显着 - 第一次，肝硬化患者停止治疗.

咬牙硬挺

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复发率相当高啊

StephenW

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低至29%.