慢性乙型肝炎抗病毒口服液停药的系统评价

StephenW

Viral Hepatitis
Discontinuation of oral antivirals in chronic hepatitis B: A systematic review
Authors

    First published: 4 March 2016Full publication history
    DOI: 10.1002/hep.28438View/save citation
    Cited by: 0 articles Check for new citations
    Article has an altmetric score of 8

    Potential conflict of interest: Dr. Wursthorn consults, advises, and received grants and lecture fees from Bristol-Myers Squibb. He consults, advises, and received lecture fees from AbbVie, Gilead, and Janssen. He received lecture fees from Roche. He received grants from Novartis. Dr. Papatheodoridis consults, advises, is on the speakers' bureau, and received grants from AbbVie, Bristol-Myers Squibb, Gilead, and Roche. He consults, advises, and is on the speakers' bureau for Janssen and MSD. He advises and is on the speakers' bureau for Novartis. Dr. Petersen consults and advises Roche, Bristol-Myers Squibb, and Gilead.

Abstract

The possibility of safe discontinuation of therapy with nucleos(t)ide analogues (NAs) remains one of the most controversial topics in the management of chronic hepatitis B. Therefore, we systematically reviewed the existing data on NA discontinuation in this setting and tried to identify factors affecting the probability of posttherapy remission. A literature search was performed in order to identify all published studies including patients who discontinued NAs in virological remission (VR) and were followed for ≥12 months thereafter. Twenty-five studies with 1716 patients were included. The pooled rates of durable VR remission were 51.4%, 39.3%, and 38.2% at 12, 24, and 36 months, respectively, after NA discontinuation, being relatively higher in initially hepatitis B e antigen (HBeAg)–positive patients (62.5%, 53.4%, 51.5%) than HBeAg-negative patients (43.7%, 31.3%, 30.1%) (P = 0.064). The weighted probability of durable biochemical remission was 65.4%, being numerically higher in HBeAg-positive than HBeAg-negative patients (76.2% versus 56.7%, P = 0.130). The weighted probability of hepatitis B surface antigen loss was 2.0%. The rates of durable VR did not significantly differ according to the VR definition (hepatitis B virus DNA <200, < 2000, < 20,000 IU/mL) or duration of on-therapy VR in HBeAg-positive patients, but they were significantly higher in studies with HBeAg-negative patients and on-therapy VR > 24 than ≤ 24 months (VR at 12 months off-NAs: 75.0% versus 35.6%, P = 0.005). The weighted probability of durable HBeAg seroconversion was 91.9% and 88.0% at 12 and 24 months, respectively, after NA discontinuation without being affected by the duration of on-therapy VR or consolidation therapy (>6 months in all studies). Conclusion: Durable VR seems to be feasible in a substantial proportion of patients who discontinue long-term NA therapy; on-therapy VR > 24 months offers higher chances of off-NA VR in patients with HBeAg-negative chronic hepatitis B. (Hepatology 2016;63:1481-1492)

StephenW

病毒性肝炎
慢性乙型肝炎抗病毒口服液停药的系统评价
作者首先公布：3月4日出版2016Full历史DOI：由引10.1002 / hep.28438查看/保存的引文：0物品检查新引用文章有8个潜在的利益冲突的altmetric评分：Wursthorn医生咨询，建议，并获得赠款和讲课费从施贵宝公司。他咨询，建议，并从艾伯维，基列，和扬森接到讲课费。他从罗氏获得的讲课费。他从诺华公司收到的补助金。 Papatheodoridis博士咨询，建议，是对扬声器的电信局，从艾伯维，施贵宝，Gilead公司和罗氏公司收到的补助。他咨询，建议，并且是扬声器的局扬森和MSD。他建议，是对扬声器的局诺华。彼得森博士咨询和建议罗氏，施贵宝和基列。
抽象
与核苷（酸）类似物（NAS）治疗的安全终止的可能性依然是慢性乙型肝炎的管理因此，最有争议的话题之一，我们系统地回顾了NA中止现有的数据在此设置中，并试图确定影响足堪缓解的可能性因素。文献检索是为了识别所有已发表的研究，包括在谁病毒学缓解（VR）停产来港，其后随访≥12个月的患者进行。二十五与1716例患者的研究都包括在内。耐用VR缓解的汇集率分别为51.4％，39.3％，并在12 38.2％，24个，36个月内，，NA停药后，作为在最初乙型肝炎e抗原（HBeAg）阳性患者相对较高的（62.5％ ，53.4％，51.5％）明显高于HBeAg阴性患者（43.7％，31.3％，30.1％）（P = 0.064）。耐用生化缓解的加权概率为65.4％，是HBeAg阳性较HBeAg阴性患者数字高（76.2％比56.7％，P = 0.130）。乙肝表面抗原损耗的加权概率是2.0％。耐用VR的发生率并没有显著根据VR定义HBeAg阳性患者不同（乙肝病毒DNA <200，<2000，<20000 IU / mL）或VR对疗法的持续时间，但他们在显著高HBeAg阴性患者和疗法VR研究> 24比24≤个月（VR在关闭的NAS12个月：75.0％比35.6％，P = 0.005）。耐用的HBeAg血清转换的概率加权分别为91.9％，12和24个月88.0％，NA停药后而不受上治疗VR或巩固治疗（> 6个月，所有的研究）的持续时间。结论：耐用VR似乎是在谁停止长期NA治疗的患者有相当比例是可行的;对疗法VR>24个月提供患者HBeAg阴性慢性乙型肝炎关闭-NA VR的几率要高（2016年肝病; 63：1481年至1492年）...