聚乙二醇干扰素α-2a与拉米夫定耐药的HBeAg阳性慢性乙型肝炎

StephenW

Source: Antiviral Ther  |  Posted 5 days ago
Efficacy and safety of peginterferon alfa-2a in patients with lamivudine-resistant HBeAg-positive chronic hepatitis B; Suh D, Lee H, Byun K, Cho M, Kweon Y, Tak W, Chon C, Koh K, Lee Y; Antiviral Therapy (Jul 2013)

   
BACKGROUND Lamivudine resistance develops in up to 80% of patients with chronic hepatitis B (CHB) after 5 years of treatment. Cross-resistance between nucleos(t)ide analogues limits management options in these patients. To investigate the role of peginterferon alfa-2a as rescue therapy in these patients, the efficacy and safety of peginterferon alfa-2a between treatment-naïve patients and lamivudine-resistant patients with hepatitis B e antigen (HBeAg)-positive CHB were compared.

METHODS A total of 150 HBeAg-positive CHB patients were stratified according to prior treatment. Lamivudine-resistant patients (n=64) and treatment-naïve patients (n=86) received peginterferon alfa-2a once-weekly for 48 weeks and were followed-up for an additional 24 weeks. Primary endpoints were HBeAg loss and hepatitis B virus (HBV) DNA less than 100,000 copies/mL at end of follow-up.

RESULTS A total of 65 (76%) treatment-naïve patients and 49 (77%) lamivudine-resistant patients completed treatment and 24 weeks of follow-up. Rates of HBeAg loss were comparable at end of follow-up between treatment-naïve patients and lamivudine-resistant patients (20.9% and 23.4%, respectively; p=0.8423). Similarly, rates of HBV DNA less than 100,000 copies/mL were comparable at end of follow-up between treatment-naïve patients and lamivudine-resistant patients (20.9% and 21.9%, respectively; p=1.000). There was no statistically significant difference in alanine aminotransferase normalization rates between treatment-naïve patients and lamivudine-resistant patients (36.0% and 29.7%, respectively; p=0.4848). One patient in each group achieved hepatitis B surface antigen (HBsAg) loss and seroconversion. The most common adverse events were those known to occur with peginterferon alfa-2a therapy and safety profiles were similar between both patient populations.

CONCLUSIONS Peginterferon alfa-2a may be effective as a rescue therapy in patients with lamivudine-resistant HBeAg-positive CHB

StephenW

背景拉米夫定耐药高达80％的慢性乙型肝炎（CHB）患者治疗5年后的发展。核苷（酸）类似物之间的交叉耐药限制在这些患者的管理选项。聚乙二醇干扰素α-2a在这些患者的抢救治疗，疗效和安全性之间的聚乙二醇干扰素α-2a治疗初治患者以及拉米夫定耐药患者乙型肝炎e抗原（HBeAg）阳性CHB调查的作用进行了比较。

方法共150例HBeAg阳性CHB患者，根据治疗前进行分层。拉米夫定耐药的患者组（n = 64）和治疗初治患者组（n = 86）接受聚乙二醇干扰素α-2a的每周一次，48周，随访24周。主要终点是在随访结束HBeAg转阴和乙肝病毒（HBV）DNA小于10万份/毫升。

结果共有65名（76％）治疗初治患者和49（77％）拉米夫定耐药的患者完成治疗和24周的随访。 HBeAg转阴率比较在后续治疗初治患者以及拉米夫定耐药的患者（分别为20.9％和23.4％，P = 0.8423）之间的结束。同样的HBV DNA小于10拷贝/ ml，费率比较在后续治疗初治患者以及拉米夫定耐药的患者（分别为20.9％和21.9％，P = 1.000）之间的结束。有谷丙转氨酶正常化率治疗初治患者以及拉米夫定耐药的患者（分别为36.0％和29.7％，P = 0.4848）之间差异无统计学意义。各组的一名患者实现乙肝表面抗原（HBsAg）的亏损和血清学转换。最常见的不良事件是那些已知的发生与聚乙二醇干扰素α-2a的治疗和安全性两者之间的患者人群相似。

结论聚乙二醇干扰素α-2a可作为拉米夫定耐药的HBeAg阳性CHB患者的抢救治疗是有效的