替诺福韦治疗在乙型肝炎e抗原阴性患者中停止后的临床复发

StephenW

Clin Gastroenterol Hepatol. 2016 Jul 9. pii: S1542-3565(16)30378-0. doi: 10.1016/j.cgh.2016.07.002. [Epub ahead of print]
Clinical Relapse After Cessation of Tenofovir Therapy in Hepatitis B e Antigen-Negative Patients.Jeng WJ1, Chen YC1, Sheen IS1, Lin CL2, Hu TH3, Chien RN2, Liaw YF4.
Author information

• 1Liver Research Unit, Chang Gung Memorial Hospital, Linkou, Taiwan; Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University College of Medicine, Taiwan.
• 2Chang Gung University College of Medicine, Taiwan; Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan.
• 3Chang Gung University College of Medicine, Taiwan; Liver Research Unit, Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
• 4Liver Research Unit, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University College of Medicine, Taiwan. Electronic address: [email protected].
  

AbstractBACKGROUND & AIMS: Of the hepatitis B e antigen-negative chronic hepatitis B patients with more than 1 year of sustained hepatitis B virus (HBV) suppression during therapy, the 1-year clinical relapse rate after cessation of entecavir therapy was 45%, of which 25.6% occurred within 6 months. The events after cessation of another preferred drug tenofovir were investigated.
METHODS: A retrospective-prospective study was conducted in 85 hepatitis B e antigen-negative chronic hepatitis B patients with sustained HBV suppression who had stopped tenofovir therapy and were monitored every 1 to 3 months for a median duration of 39 weeks (range, 4-133 wk).
RESULTS: Clinical relapse occurred in 38 patients, 57.9% and 86.8% within 3 and 6 months, respectively, with an estimated 1-year cumulative incidence of 52%. The optimal duration of therapy and consolidation therapy were calculated to be 3 and 2 years, respectively. Of the relapsers, 81.6% and 57.9% showed an alanine aminotransferase level greater than 5 and 10 times the upper limit of normal, respectively, 23.7% showed a bilirubin level of 2 mg/dL or greater, and 2 developed hepatic decompensation. Relapsers had significantly higher pretherapy baseline hepatitis B surface antigen level, more prior anti-HBV therapy experience, later alanine aminotransferase level normalization, and a shorter duration of treatment and consolidation therapy. Cox regression analyses showed that treatment for more than 3 years combined with consolidation therapy for more than 2 years was an independent significant manageable factor of clinical relapse (adjusted hazard ratio, 0.387; P = .008). With this combination, the clinical relapse rate was reduced to 30%.
CONCLUSIONS: Clinical relapses occurred mostly within 6 months, with high alanine aminotransferase and serum bilirubin levels. Closer monitoring, monthly in the first 3 to 6 months, with timely re-treatment is mandatory for a safe cessation of tenofovir therapy.

Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

KEYWORDS: Chronic Hepatitis B; Cirrhosis; Consolidation Therapy; Hepatic Decompensation; Hepatitis B Surface Antigen

PMID:27404969DOI:10.1016/j.cgh.2016.07.002

StephenW

Clin Gastroenterol Hepatol。 2016 Jul 9. pii：S1542-3565（16）30378-0。 doi：10.1016 / j.cgh.2016.07.002。 [打印前的电子版]
替诺福韦治疗在乙型肝炎e抗原阴性患者中停止后的临床复发。
Jeng WJ1，Chen YC1，Sheen IS1，Lin CL2，Hu TH3，Chien RN2，Liaw YF4。
作者信息

    台湾林口长庚纪念医院肝内研究室;台湾林口长庚纪念医院肝脏病学，胃肠病学与肝病学系;长庚大学医学院台湾。
    台湾大学医学院;台湾基隆长庚纪念医院肝研究室。
    台湾大学医学院;台湾高雄长庚纪念医院肝研究室;台湾高雄长庚纪念医院肝内科医学系内科。
    4台湾林口长庚纪念医院肝研究室;长庚大学医学院台湾。电子邮件地址：[email protected]。

抽象
背景与目的：

在治疗期间持续性乙型肝炎病毒（HBV）抑制1年以上的乙型肝炎e抗原阴性慢性乙型肝炎患者中，恩替卡韦治疗停止后的1年临床复发率为45％，其中25.6％发生6个月内。研究了停止另一种优选药物替诺福韦后的事件。
方法：

回顾性前瞻性研究在持续HBV抑制的停止替诺福韦治疗的85例乙型肝炎e抗原阴性慢性乙型肝炎患者中进行，每1至3个月监测一次，中位持续时间为39周（范围，4-133周）。
结果：

38例患者发生临床复发，3个月和6个月内分别为57.9％和86.8％，估计1年累积发生率为52％。治疗和巩固治疗的最佳持续时间分别计算为3和2年。在复发者中，81.6％和57.9％分别显示丙氨酸转氨酶水平大于正常上限的5倍和10倍，23.7％显示胆红素水平为2mg / dL或更大，2例发生肝失代偿。复发者具有显着较高的治疗前基线乙型肝炎表面抗原水平，更早的抗HBV治疗经验，后来的丙氨酸氨基转移酶水平正常化，以及较短的治疗和巩固治疗的持续时间。 Cox回归分析显示，超过3年的治疗结合巩固治疗2年以上是临床复发的独立重要的可控因素（调整的风险比，0.387; P = .008）。使用该组合，临床复发率降低至30％。
结论：

临床复发主要发生在6个月内，具有高丙氨酸氨基转移酶和血清胆红素水平。更密切的监测，每月在前3〜6个月，及时的再治疗是强制性的替诺福韦治疗的安全停止。

版权所有©2016 AGA Institute。发布者Elsevier Inc.保留所有权利。
关键词：

慢性乙型肝炎;肝硬化;巩固治疗;肝脏去补偿;乙型肝炎表面抗原

PMID：
    27404969
DOI：
    10.1016 / j.cgh.2016.07.002

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把一些垃圾文章顶到第二页面去，版主跑哪去了？