大部分肝硬化HBV患者受益于增加阿德福韦拉米夫定

StephenW

‘Most’ cirrhotic HBV patients benefit from adding adefovir to lamivudine
Published on February 23, 2015 at 9:15 AM · No Comments


By Shreeya Nanda, Senior medwireNews Reporter

Response-guided addition of adefovir to lamivudine-based therapy not only maintains long-term viral suppression in Chinese chronic hepatitis B patients with compensated liver cirrhosis, research suggests, but also improves liver function.

In this prospective study, 100 patients were assigned to different groups based on serum hepatitis B virus (HBV) levels after 24 weeks of lamivudine treatment, report Hong Wang (Fudan University, Shanghai, China) and co-workers in the World Journal of Gastroenterology.

Specifically, patients with complete and partial virological responses to lamivudine, defined as HBV levels of 60 IU/mL or below and between 60 IU/mL and 2000 IU/mL, respectively, were given adefovir in addition to ongoing lamivudine at week 48. But for those with an inadequate response, that is, with serum HBV levels higher than 2000 IU/mL, adefovir was added earlier, at week 24.


For individuals with a partial or inadequate response, the addition of adefovir resulted in a further reduction in serum HBV levels of around 1 log10 IU/mL. And by week 72, partial response patients had achieved a median HBV DNA level below the lower limit of detection, a target that was not reached in inadequate response patients during the course of treatment.

At week 144, the undetectable HBV DNA rate varied significantly between the 49, 31 and 20 patients who had a complete, partial or inadequate response, at 95.96%, 66.67% and 35.29%, respectively.

The proportion of patients with YMDD mutations in the HBV reverse transcriptase gene, associated with lamivudine resistance, also differed significantly between the groups, at 0.00% in complete response patients, and 3.23% and 15.00% in those with a partial and inadequate response, respectively.

Serum alanine aminotransferase levels were significantly lower and serum albumin levels significantly higher at week 48 than at baseline in all groups. The researchers point out, however, that these changes were attributable to lamivudine therapy alone in participants with complete and partial responses, but to the combination of lamivudine and adefovir in inadequate response patients.

Thus, patients with a complete or partial response to lamivudine can benefit from the addition of adefovir, say the authors, but, noting that HBV DNA levels did not decrease markedly from week 24 to 48 in partial response patients, they propose the immediate add-on of adefovir at week 24.

Given the poorer response of inadequate response patients, despite the earlier initiation of adefovir, the team suggests “switching to more potent antiviral agents with a high genetic barrier and without cross-resistance to [lamivudine] would be a better choice”.

Licensed from medwireNews with permission from Springer Healthcare Ltd. ©Springer Healthcare Ltd. All rights reserved. Neither of these parties endorse or recommend any commercial products, services, or equipment.

StephenW

“最”肝硬化HBV患者受益于增加阿德福韦拉米夫定
发布于2015年2月23日上午9:15·没有评论


通过Shreeya南大，高级medwireNews记者

应答指导除了阿德福韦拉米夫定为基础的治疗不仅保持长期抑制病毒在中国慢性乙型肝炎患者的肝功能代偿性肝硬化，研究表明，又提高肝功能。

在这项前瞻性研究中，100名患者被分配到基于血清乙肝病毒不同群体（HBV）水平拉米夫定治疗24周后，报鸿旺（复旦大学，上海，中国）和同事在胃肠病学世界日报。

具体地讲，患者完全和部分病毒学反应拉米夫定，定义为60国际单位/毫升或以下的水平的HBV和60国际单位/毫升和2000国际单位/毫升，除了正在进行拉米夫定在48周分别给予阿德福韦但是之间对于那些反应不足，那就是，血清HBV水平高于2000 IU / mL时，阿德福韦前面加较高，为24周。


对于具有部分或反应不足的个体，在加入阿德​​福韦导致进一步降低约1 log10的国际单位/毫升的血清HBV水平。和72周，部分响应的患者达到了低于检测下限的中值的HBV DNA水平，响应不足的患者的治疗过程中，这不是访问的目标。

在144周，检测不到HBV DNA率49，31和20例谁了一个完整的，部分或反应不足，分别为95.96％，66.67％和35.29％，与显著变化。

患者的YMDD突变的HBV逆转录酶基因，与拉米夫定耐药相关的比例，也显著组与组之间差异，在完全缓解的患者0.00％，和3.23％和15.00％，在那些有局部的和不充分的反应，分别。

血清谷丙转氨酶水平显著降低和血清白蛋白水平显著高于48周时比在基准中的所有组。然而，研究人员指出的是，这些变化归因于单独拉米夫定治疗中的参与者与完全和部分反应，但对拉米夫定和阿德福韦响应患者不足的组合。

因此，患者对拉米夫定的全部或部分反应可以受益于另外阿德福韦，作者说，但是，同时指出HBV DNA水平没有显着从第24周在部分响应的患者减少到48，他们提出了直接添加 - 对阿德福韦在24周。

鉴于患者的反应不足反应较差，尽管阿德福韦较早开始，团队建议“切换为更有效的具有高基因屏障，无交叉耐药性[拉米夫定]抗病毒药物将是一个更好的选择。”

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君看一叶舟

对拉米加阿的的联合治疗疗效研究

君看一叶舟

对拉米加阿德的联合治疗疗效研究

9病成医

免疫已经充分激活的老乙肝，拉米加阿德也足以解决问题。