“简单”的模型预测在慢性HBV PegIFN响应

StephenW

'Simple' model predicts PegIFN response in chronic HBV
Published on June 23, 2016 at 1:15 AM · No Comments


By Shreeya Nanda

Chinese researchers have developed a scoring system based on hepatitis B virus (HBV)-related clinical parameters to predict response to pegylated-interferon (PegIFN) in chronic HBV patients.

Their "simple but practical" model could help to determine optimal candidates for PegIFN therapy, which the authors say is an important goal as PegIFN has "suboptimal efficacy, high cost, and multiple adverse events".

In this study, reported in the Journal of Gastroenterology and Hepatology, 85 treatment-naïve patients were treated with PegIFN alpha-2a for 52 weeks and subsequently followed up for 24 weeks to assess response, defined as hepatitis B e antigen (HBeAg) seroconversion. Clinical parameters were evaluated at baseline, during treatment (at 12, 24 and 52 weeks) and at the end of the follow-up period.

Multivariate analysis showed that the major predictors of response at 76 weeks were levels of alanine aminotransferase (ALT), HBeAg and antibody to hepatitis B core antigen (anti-HBc), and decline in levels of HBeAg and HBV DNA. A scoring system was established using the three most relevant parameters at each timepoint, such that if a parameter met the optimal cutoff, a score of 1 was assigned, otherwise the patient scored 0, giving a total score of up to 3.

For instance, the most meaningful factors at baseline were ALT levels above five times the upper limit of normal, HBeAg levels no higher than 500 S/CO and anti-HBc levels over 10.7 S/CO. Using a prediction model based on these, response rates varied from 6.3% for patients who scored 0 and 90.0% for those who scored 3.

Similarly for scores of 0 versus 3 based on the relevant variables at weeks 12, 24 and 52, response rates were 12.5% versus 83.3%, 0.0% versus 76.9% and 0.0% versus 86.4%, respectively.

The team from Anhui Medical University found that scoring 0 or 1 correlated negatively with response rate at 76 weeks, which decreased with an increase in the number of instances of scoring 0 or 1. Participants who scored 1 or below at three or four timepoints had HBeAg seroconversion rates of 10.5% and 0.0%, respectively. By contrast, those with scores of 2 or above on three or four occasions had response rates ranging from 65.2% to 82.4%.

Zhen-Hua Zhang and colleagues thus propose that patients with a score of 0 at any timepoint or multiple scores of 1 should not receive PegIFN monotherapy, and other options should be considered. However, patients scoring 2 or 3 at baseline or on-treatment should continue and complete PegIFN treatment.
Source:

J Gastroenterol Hepatol 2016; Advance online publication

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StephenW

“简单”的模型预测在慢性HBV PegIFN响应
在上午1:15·没有评论发表于2016年6月23日，


通过Shreeya南达

中国的研究人员已经开发出一种基于乙型肝炎病毒（HBV）计分制 - 相关临床指标来预测响应的慢性HBV患者聚乙二醇化干扰素（PegIFN）。

他们的“简单实用”的模式可以帮助确定PegIFN治疗的最佳人选，这对作者说是一个重要的目标是PegIFN有“疗效不理想，成本高，以及多个不良事件”。

在这项研究中，报告了胃肠病学和肝病学，85治疗初治患者接受PegIFN阿尔法-2A治疗52周，随后随访24周来评估响应，定义为乙型肝炎e抗原（HBeAg）血清学转换。临床参数基线进行了评价，在治疗期间（在第12，第24和52周），并在后续期结束。

多因素分析表明，在76周内的回应的主要预测指标是乙肝核心抗原（抗-HBc），并在HBeAg和HBV DNA水平下降丙氨酸氨基转移酶（ALT），HBeAg和抗体的水平。使用三个最相关的参数在每个时间点建立了一种评分系统，使得如果参数满足最优截止，1分被分配，否则患者得分0，放弃至3中的总成绩。

例如，在基线的最有意义的因素是上面五倍正常，HBeAg的水平不高于500 S / CO抗HBc水平超过10.7 S / CO更高和的上限ALT水平。使用基于这些预测模型，应答率从6.3％变化为谁得分0和90.0％为那些谁拿下3例。

同样，对于根据相关变量在周12，24和52的0与分数，应答率分别为12.5％和83.3％，0.0％和76.9％和0.0％比86.4％。

来自安徽医科大学的研究小组发现，进0或1，在76周，这与增加得分0的情况下，或1。参与者的人数谁在三个打进1或以下四个时间点有大三阳减少负应答率相关分别为10.5％和0.0％，血清转换率。相反，那些有三个或四次的2个或以上的分数有响应率从65.2％至82.4％。

振张华和他的同事因此建议患者在任何时间点或1分多得分为0不应该接受PegIFN单药治疗，和其他选项可考虑。然而，患者打进2或3在基线或在治疗应继续并完成PegIFN治疗。
资源：

ĴGastroenterol肝脏病2016年;推进网上公布

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