功效替诺福韦治疗开关的核苷（酸）IDE经验的患者有慢性乙

StephenW

Efficacy of tenofovir switch therapy for nucleos(t)ide-experienced patients with chronic hepatitis B

    A. O.-S. Lo1,2,3, V. W.-S. Wong1,2,3, G. L.-H. Wong1,2,3, Y.-K. Tse1,2,3, H.-Y. Chan1,2,3 andH. L.-Y. Chan1,2,3,*

Article first published online: 31 MAR 2015

DOI: 10.1111/apt.13185

© 2015 John Wiley & Sons Ltd

Issue
Volume 41, Issue 11, pages 1190–1199, June 2015
Article has an altmetric score of 4


    1    Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
    2    Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
    3    State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong

* Correspondence to:
Prof. H. L.-Y. Chan, Department of Medicine and Therapeutics, 9/F, Lui Che Woo Clinical Science Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong.
E-mail: [email protected]

    This article was accepted for publication after full peer-review.

Summary
Background

Tenofovir disoproxil fumarate has been used in chronic hepatitis B patients with suboptimal virologic response to nucleos(t)ide analogues. The efficacy of tenofovir switch therapy has not been well studied in Asian patients.
Aim

To evaluate the efficacy of tenofovir switch therapy in nucleos(t)ide-experienced patients, and identify the factors associated with treatment response of tenofovir switch therapy.
Methods

Nucleos(t)ide-experienced hepatitis B e antigen-positive and -negative patients prescribed with tenofovir were retrospectively identified and recruited for prospective analysis. Hepatitis B virus (HBV) DNA and other biochemical parameters were monitored in regular 3–6 monthly follow-up visits. Primary efficacy endpoint was maintained-virologic response with tenofovir switch therapy, defined as undetectable HBV DNA (<20 IU/mL) until the last follow-up visit.
Results

An overall of 214/252 (84.9%) patients achieved maintained-virologic response after 22 (7–55) months of tenofovir switch therapy. On multivariate analysis, a lower HBV DNA level at the time of switching to tenofovir was an independent factor associated with treatment efficacy. Maintained-virologic response after switching to tenofovir was achieved in 177/190 (93.2%) patients with HBV DNA <20 000 IU/mL vs. 37/62 (59.7%) patients with HBV DNA ≥20 000 IU/mL (P < 0.001). Absence of genotypic resistance to lamivudine or adefovir dipivoxil was not associated with improved treatment outcome.
Conclusions

Tenofovir switch therapy is an effective treatment strategy in nucleos(t)ide-experienced chronic hepatitis B patients. However, in patients with HBV DNA ≥20 000 IU/mL at the time of switching to tenofovir, the chance of achieving maintained undetectable HBV DNA is significantly reduced.

StephenW

功效替诺福韦治疗开关的核苷（酸）IDE经验的患者有慢性乙型肝炎

    A. O.-S. LO1,2,3，五W.-S. Wong1,2,3，G L.-H. Wong1,2,3，Y.-K. Tse1,2,3，H.-Y. Chan1,2,3 andH。 L.-Y. Chan1,2,3，*

文章首次在线发表：2015年3月31日

DOI：10.1111 / apt.13185

2015年©约翰·威利父子有限公司

问题


第41卷，第11期，页1190至1199年，2015年6月
文章有altmetric比分4


    内科及药物治疗，香港中国大学，香港1系
    消化系统疾病香港大学中国研究所2，香港
    消化系统疾病，香港的中国大学，香港国家重点实验室

*通讯作者：
H. L.-Y.教授成龙，内科及药物治疗，9 /楼吕志和临床科学大楼，威尔斯亲王医院，银城街30-32，沙田，香港系。
电子信箱：[email protected]

    这篇文章被接受后满同行评审的出版物。

总结
背景

富马酸替诺福韦酯已被用于治疗慢性乙型肝炎患者的次优病毒学反应核苷（酸）类似物。替诺福韦开关治疗的疗效尚未得到很好的研究在亚洲患者。
目的

为了评估替诺福韦开关疗法的疗效在核苷（酸）的IDE经验的患者，并确定与替诺福韦开关疗法的治疗反应有关的因素。
方法

规定与替诺福韦核苷（酸）IDE-经历乙型肝炎e抗原阳性和阴性的患者进行回顾性确定和招募的前瞻性分析。乙型肝炎病毒（HBV）DNA和其他生化指标在每月定期随访3-6进行了监测。主要疗效终点是替诺福韦治疗开关保持-病毒学应答，定义为检测不到HBV DNA（<20 IU / mL）中，直到最后随访。
结果

的二百五十二分之二百一十四（84.9％）患者的整体实现后，替诺福韦治疗开关22（7-55）个月保持-病毒学应答。多变量分析显示，在切换到替诺福韦的时间较低的HBV DNA水平与疗效相关的独立因素。切换到替诺福韦后保持-病毒学应答是在一百九十零分之一百七十七（93.2％）的患者实现了与HBV DNA <20 000 IU / mL相对62分之37（59.7％）患者的HBV DNA≥20000 IU /毫升（P < 0.001）。拉米夫定或阿德福韦酯基因型耐药的缺席是不是与改善治疗结果有关。
结论

替诺福韦治疗开关是核苷（酸）IDE经验的慢性乙肝患者有效的治疗策略。然而，在患者的HBV DNA≥20000 IU / mL的在切换到替诺福韦的时间，的机会实现保持检测不到HBV DNA被显著降低。

阳光醉人

什么意思？史蒂文大神，能不能总结一两句啊，谢谢！

StephenW

回复 阳光醉人 的帖子

改用替诺是有效的治疗策略.
在改用替诺时HBV DNA<20000 IU / mL的患者,  93.2%可以实现"保持检测不到HBV DNA".
在改用替诺时HBV DNA≥20000 IU / mL的患者,  可以实现"保持检测不到HBV DNA"的机会显著降低(59.7%)