乙型肝炎e抗原血清学转换的慢性乙型肝炎患者的耐用性治疗

StephenW

Dig Dis Sci. 2015 Jul 3. [Epub ahead of print]
Durability of Hepatitis B e Antigen Seroconversion in Chronic Hepatitis B Patients Treated with Entecavir or Tenofovir.Fong TL1, Tien A, Jo KJ, Chu D, Cheung E, Mena EA, Phan QQ, Yu AS, Mohammed W, Velasco A, LeDuc VH, Nguyen N, Han SB, Chang M, Bae HS, Cho YW, Tong MJ, Cooper SL.
Author information

• 1Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA, [email protected].
  

AbstractINTRODUCTION: Loss of HBeAg and development of anti-HBe (seroconversion) is seen as a milestone and endpoint in the treatment of HBeAg-positive patients with chronic hepatitis B (CHB). Among patients treated with nucleos(t)ide analogs (NA), recurrent viremia is common after discontinuation of therapy. Entecavir (ETV) and tenofovir (TDF) are highly potent NA. The durability of virological response and HBeAg seroconversion in patients treated with these agents is not well studied.
METHODS: We retrospectively studied the outcomes of 54 HBeAg-positive CHB patients who were treated with either ETV (n = 30) or TDF (23) or both (n = 1) that achieved virological response and underwent seroconversion and consolidation therapy before cessation of treatment.
RESULTS: Only 4 (7 %) patients had sustained virological, serological, and biochemical remission. Thirteen patients (24 %) continued to have HBV DNA levels below 2000 IU/mL and normal alanine aminotransferase activity (ALT). Thirty-seven patients (69 %) developed HBV DNA >2000 IU/mL, with 20 having elevated ALT. Among these 37 patients, 23 (62 %) remained HBeAg negative/anti-HBe positive, 12 (32 %) became HBeAg positive, and 2 (5 %) were HBeAg and anti-HBe negative. Duration of consolidation therapy did not correlate with low versus high level of virological relapse.
CONCLUSIONS: Durability of HBeAg seroconversion associated with ETV or TDF was not superior to that reported in patients treated with less potent NA. Our results, aggregated with others, suggest HBeAg seroconversion should not be considered as a treatment endpoint for most HBeAg-positive patients treated with NA. Future updates of treatment guidelines should reconsider HBeAg seroconversion as an endpoint to therapy.

StephenW

挖派息科学。 2015年3月[EPUB的提前打印]
乙型肝炎e抗原血清学转换的慢性乙型肝炎患者的耐用性治疗恩替卡韦或替诺福韦。
芳TL1，天A，乔KJ，楚D，翔E，梅纳EA，藩QQ，俞AS，穆罕默德·W，贝拉斯科A，勒杜克VH，阮N，韩SB，张男，裴HS，赵YW，佟MJ ，库珀SL。
作者信息

    1Asian亚太肝病中心，圣文森特医疗中心，洛杉矶，CA，USA，[email protected]。

抽象
简介：

HBeAg消失和抗HBe（血清转换）的发展被视为一个里程碑，端点HBeAg阳性慢性乙型肝炎（CHB）的治疗。在与核苷（酸）类似物（NA）治疗的患者，复发性病毒血症的治疗停药后常见。恩替卡韦（ETV）和替诺福韦（TDF）是高度有效的NA。病毒学应答和血清转换与这些药物治疗的患者的耐久性没有得到很好的研究。
方法：

我们回顾性研究了54例HBeAg阳性CHB患者谁是无论用恩替卡韦（N = 30）或TDF（23）处理或两者的结果（N = 1）取得病毒学应答和戒烟治疗前血清转换行和巩固治疗。
结果：

只有4（7％）的患者有持续病毒学，血清学和生化缓解。 13例（24％）仍然低于2000 IU / mL的HBV DNA水平和正常的谷丙转氨酶酶（ALT）。 37例（69％）开发的HBV DNA> 2000 IU / mL时，具有20 ALT升高。其中37名患者，23（62％）仍然是HBeAg阴性/抗HBe阳性，12（32％）成为HBeAg阳性，和2（5％）是HBeAg和抗-HBe阴性。巩固治疗的持续时间并没有相关的病毒学复发的低与高的水平。
结论：

与ETV或TDF相关血清转换的耐久性并不优于中报道的与较低效力的NA治疗的患者。我们的研究结果，汇总与他人，建议HBeAg血清不应该被认为作为与NA处理的最HBeAg阳性患者的治疗终点。治疗指南未来的更新应重新考虑HBeAg血清学转换为一个端点治疗。

682256

看来e抗原转换是否可以作为恩替或替诺的停药依据，需要重新考虑了。

682256

看来e抗原转换是否可以作为恩替或替诺的停药依据，需要重新考虑了。

682256

看来e抗原转换是否可以作为恩替或替诺的停药依据，需要重新考虑了。

682256

看来e抗原转换是否可以作为恩替或替诺的停药依据，需要重新考虑了。

682256

看来e抗原转换是否可以作为恩替或替诺的停药依据，需要重新考虑了。

682256

看来e抗原转换是否可以作为恩替或替诺的停药依据，需要重新考虑了。

682256

看来e抗原转换是否可以作为恩替或替诺的停药依据，需要重新考虑了。

682256

不好意思，键盘故障，多摁几下，出现以上重复。 也就是说，e抗原转换，将不再是抗病毒用药的停药点。