基于干扰素治疗可以改善D型肝炎病毒感染的临床结果

StephenW

Interferon-based therapy improves clinical outcomes in hepatitis delta infection
April 21, 2016

   

BARCELONA — Patients with hepatitis delta virus infection treated with pegylated interferon alpha were less likely to develop clinical outcomes — like decompensation or hepatocellular carcinoma — compared with patients who received nucleos(t)ide-based treatment or no treatment at all, according to a presentation at International Liver Congress.   



“Interferon-based therapy should still be recommended for the treatment of hepatitis delta. … Alternative treatment options are urgently needed for [pegylated interferon alpha] nonresponder patients or patients with contraindications for [pegylated interferon alpha],” Anika Wranke, fellow at Hannover Medical School, Germany said during her presentation.

Researchers screened all patients enrolled at Hannover Medical School between 1987 and 2012 positive for hepatitis B surface antigen (HBsAg) plus hepatitis delta antibodies or HDV RNA (n = 386). The goal of the study was to determine the long-term outcomes of different treatment strategies for hepatitis delta. Some patients received treatment with an interferon-based regimen (pegylated interferon alpha), treatment with hepatitis B virus polymerase inhibitors (nucleos(t)ides) or no treatment at all.

Final analysis included 136 patients followed for a minimum of 6 months. The mean age of the cohort was 38 years and 67% were male. Of these patients, 52 received pegylated interferon alpha therapy, 45 received nucleos(t)ides and 39 did not receive any therapy.

Overall, 55 patients met clinical endpoints: liver transplantation (n = 26), decompensation (n = 54), hepatocellular carcinoma (n = 10) or died (n = 7).

Chisquare analysis showed patients who received pegylated interferon alpha developed less frequently clinical endpoints (n = 9) compared with patients treated with nucleos(t)ides (n = 29) or untreated (n = 17; P < .01 for both).

One hundred and fourteen patients had available HDV RNA data. Chisquare analysis also showed that pegylated interferon alpha treatment was associated with an increased loss in HDV RNA (18/43) compared with untreated patients (6/28) and patients treated with nucleos(t)ides (8/42; P = .02). Out of the 43 patients treated with pegylated interferon alpha, 18 achieved sustained suppression of HDV RNA.

However, patients who responded to therapy had a more beneficial outcome than untreated patients or patients treated with nucleos(t)ides (HR = 4.2; 95% CI, 1.3–13.5), which was not the case for pegylated interferon alpha-nonresponding patients (HR = 1.8; 95% CI, 0.8–4.4) in Kaplan Meier analysis, according to Wranke’s presentation.

Multivariate analysis revealed that among albumin, platelet count and positive HBeAg, pegylated interferon alpha therapy (P = .03) was independently associated with a favorable outcome.

“Patients who received [pegylated interferon alpha]-based therapies developed less frequently clinical endpoints than patients treated with [nucleos(t)ides] only or untreated patients. … Prospective studies are needed to determine the potential clinical benefit of HDV RNA response to [pegylated interferon alpha] treatment for HDV-infected patients,” Wranke said.  – by Melinda Stevens

Reference:

Wranke, et al. Abstract PS053. Presented at: International Liver Congress; April 13-17, 2016; Barcelona.

Disclosure: Wranke reports no relevant financial disclosures. Please see the full abstract for a list of all other authors’ relevant financial disclosures.

StephenW

基于干扰素治疗可以改善型肝炎病毒感染的临床结果
2016年4月21日

   

巴塞罗那 - 患者用干扰素α治疗丁型肝炎病毒感染是不太可能发展临床结果 - 就像失代偿或肝细胞癌 - 与谁接受核苷（酸）基于IDE的治疗或没有治疗的患者相比，根据演示在国际肝病大会。



“基于干扰素治疗仍应建议丁型肝炎的治疗。 ......目前亟需向[聚乙二醇化干扰素α-无反应患者或患者的禁忌[聚乙二醇化干扰素α-，“阿尼卡Wranke，研究员汉诺威医学院，德国她的介绍中说替代治疗方案。

研究人员筛选就读于汉诺威医学院所有患者1​​987年和2012阳性乙肝表面抗原（HBsAg），加上丁型肝炎抗体或HDV RNA（N = 386）之间。该研究的目标是确定的为丁型肝炎不同的治疗策略的长期结果。一些患者接受与基于干扰素方案（聚乙二醇化的干扰素α），治疗乙肝病毒聚合酶抑制剂（核苷（酸）的IDE）或根本没有治疗的治疗。

最终分析包括136例患者随访至少6个月。队列的平均年龄为38岁，67％为男性。在这些患者中，52接受聚乙二醇干扰素α治疗，45收到核苷（酸）IDE和39未接受任何治疗。

总体而言，55例符合临床终点：肝移植（26例），代偿（N = 54），肝癌（N = 10）或死亡（N = 7）。

卡方分析表明，谁收到干扰素α患者出现较少的临床终点（N = 9）与核苷（酸）治疗的患者相比，集成开发环境（N = 29）或未经处理的（N = 17，P <0.01两个）。

一百一十四例患者可HDV RNA数据。卡方分析还表明，聚乙二醇化的干扰素α治疗与用核苷（酸）的IDE（8/42治疗未经治疗的患者（6/28）和患者相比以HDV RNA损失增加（18/43）相关联; P = 0.02 ）。出与干扰素α治疗的43例患者中，18个实现了HDV RNA的持续抑制。

然而，谁回答治疗的患者有一个更有利的结果比用核苷（酸）的IDE未经治疗的患者或患者（HR = 4.2; 95％CI，1.3-13.5），这是不是聚乙二醇化干扰素α-无反应的患者的情况下（HR = 1.8; 95％CI，0.8-4.4）的卡普兰Meier分析，根据Wranke的演讲。

多因素分析发现，白蛋白中，血小板计数及HBeAg阳性，聚乙二醇化干扰素α治疗（P = 0.03）具有有利的结果独立相关。

“谁收到[聚乙二醇化干扰素α-基于疗法欠发达频繁临床终点比[核苷（酸）的IDE]唯一或未经治疗的患者治疗的患者患者。 ...需要前瞻性研究来确定的HDV的RNA响应于[聚乙二醇化干扰素α-治疗HDV感染患者的潜在临床受益，“Wranke所述。 - 通过梅林达·史蒂文斯

参考：

Wranke，等。摘要PS053。发表在：国际肝病会议; 4月13日至17日，2016年巴塞罗那。

披露：Wranke报告没有相关财务披露。请参阅完整的抽象的所有其他作者的相关财务信息披露的名单。