表面抗原水平响应制导聚乙二醇干扰素治疗乙型肝炎e抗原阳

StephenW

Hepatology. 2013 Apr 2. doi: 10.1002/hep.26436. [Epub ahead of print]
Response-guided peginterferon therapy in hepatitis B e antigen-positive chronic hepatitis B using serum hepatitis B surface antigen levels.
Sonneveld MJ, Hansen BE, Piratvisuth T, Jia JD, Zeuzem S, Gane E, Liaw YF, Xie Q, Heathcote EJ, Chan HL, Janssen HL.
Source

Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Abstract

On-treatment levels of hepatitis B surface antigen (HBsAg) may predict response to peginterferon (PEG-IFN) therapy in chronic hepatitis B (CHB), but previously proposed prediction rules have shown limited external validity. We analyzed 803 HBeAg-positive patients treated with PEG-IFN in three global studies with available HBsAg measurements. A stopping-rule based on absence of a decline from baseline was compared to a prediction-rule that uses HBsAg levels of <1,500 IU/mL and >20,000 IU/mL to identify patients with high and low probabilities of response. Patients with an HBsAg level <1,500 IU/mL at week 12 achieved response (HBeAg loss with HBV DNA <2,000 IU/mL at 6 months posttreatment) in 45%. At week 12, patients without a decline in HBsAg achieved a response in 14%, compared to only 6% of patients with HBsAg >20,000 IU/mL, but performance varied across HBV genotype. In patients treated with PEG-IFN monotherapy (n = 465), response rates were low in patients with genotypes A or D if there was no decline of HBsAg by week 12 (negative predictive value [NPV]: 97%-100%), and in patients with genotypes B or C if HBsAg at week 12 was >20,000 IU/mL (NPV: 92%-98%). At week 24, nearly all patients with HBsAg >20,000 IU/mL failed to achieve a response, irrespective of HBV genotype (NPV for response and HBsAg loss 99% and 100%). Conclusion: HBsAg is a strong predictor of response to PEG-IFN in HBeAg-positive CHB. HBV genotype-specific stopping-rules may be considered at week 12, but treatment discontinuation is indicated in all patients with HBsAg >20,000 IU/mL at week 24, irrespective of HBV genotype. (Hepatology 2013).

StephenW

Sonneveld MJ，汉森，甘恩，Zeuzem佳JD Piratvisuth T，S，E，YF LIAW，谢倩，希思科特EJ，陈HL，扬森HL。
源

胃肠病学和肝病学系，伊拉兹马斯MC大学医学中心，鹿特丹，荷兰。
抽象

B型肝炎表面抗原（HBsAg）的处理水平的可预测聚乙二醇化（PEG-IFN）治疗慢性乙型肝炎（CHB）的响应，但是，以前提出的预测规则，显示出有限的外部效度。我们分析了三个全球研究与现有的乙肝表面抗原测量与PEG-IFN治疗的803例HBeAg阳性患者。没有从基线下降的基础上的停止规则进行比较的预测规则，使用<1500 IU /毫升，HBsAg水平> 20,000 IU / mL的高和低的响应概率以确定患者。患者与乙肝表面抗原水平<1,500 IU / mL的响应（HBeAg消失，HBV DNA <2,000 IU / mL的6个月的治疗后）在第12周达到45％。在第12周，患者无HBsAg的下降，实现了14％的反应相比，只有6％的患者乙肝表面抗原> 20,000 IU / mL的; HBV基因型各不相同，但性能。在PEG-干扰素单药治疗组（n = 465）治疗的患者中，基因型患者的应答率分别为低，A或D，如果没有下降的HBsAg第12周（阴性预测值[NPV]：97％-100％），如果12周时乙肝表面抗原，B或C基因型患者> 20,000 IU / ML（NPV：92％-98％）。在第24周，几乎所有的患者与HBsAg> 20,000 IU / mL的未能实现的响应，不论HBV基因型（NPV响应和HBsAg损失99％和100％）。结论：乙肝表面抗原是一个强有力的预测PEG-IFN HBeAg阳性CHB。 HBV基因型特异性停止规则可能被认为是在第12周，但停药显示所有患者的乙肝表面抗原> 20,000 IU / mL的24周时，HBV基因型无关。 （2013肝病）。