在拉米和阿德联合治疗, 拉米终止后病毒学应答的耐久性

StephenW

J Med Virol. 2017 Jan;89(1):85-90. doi: 10.1002/jmv.24616. Epub  2016 Jul 11.
Durability of the virological response after lamivudine discontinuation in lamivudine-resistant patients with a complete virological response after lamivudine and adefovir combination therapy.Kim MN1, Park JY2,3,4, Ahn SH5,6,7, Kim BK5,6,7, Kim SU5,6,7, Kim DY5,6,7, Han KH5,6,7.
Author information

• 1Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
• 2Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. [email protected].
• 3Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. [email protected].
• 4Yonsei Liver Center, Yonsei University Health System, Seoul, Korea. [email protected].
• 5Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
• 6Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
• 7Yonsei Liver Center, Yonsei University Health System, Seoul, Korea.
  

AbstractWe investigated the durability of virological response after lamivudine (LAM) discontinuation in LAM-resistant chronic hepatitis B (CHB) patients with complete virological response after LAM-adefovir (ADV) combination therapy. We enrolled 58 patients switched to ADV monotherapy with undetectable viral loads (<12 IU/ml) and normal alanine aminotransferase levels after ADV add-on combination treatment for at least 6 months in LAM-resistant CHB patients. Virologic relapse was defined as HBV DNA detection at more than 20 IU/ml by quantitative polymerase chain reaction determined on two consecutive measurements. During median 40.9 months of follow-up (range 11.5-79.0 months), seven (12.1%) patients experienced virological relapse. The cumulative rate of virological relapse at 3 and 5 years was 5.5% and 22.4%, respectively. Two patients had elevated alanine aminotransferase during virological relapse. These seven patients with virological relapse had undetectable HBV DNA after switching to tenofovir therapy. In our study, switching to ADV monotherapy resulted in sustained HBV DNA suppression in 87.9% of the patients during median 40.9 months follow-up. This adapting step-down strategy, switching from combination therapy to monotherapy in virologically suppressed CHB patients with stable liver disease, may reduce the cost burden and the risk of potentially harmful effects of combination therapy. J. Med. Virol. 89:85-90, 2017. © 2016 Wiley Periodicals, Inc.

© 2016 Wiley Periodicals, Inc.

KEYWORDS: antiviral agents; hepatitis B virus; resistance

PMID:27357598DOI:10.1002/jmv.24616

StephenW

在拉米和阿德联合治疗后，拉米终止后病毒学应答的耐久性的病具有完全病毒学应答的拉米夫定耐药患者中拉米终止后的病毒学应答的耐久性。
J Med Virol。 2017 Jan; 89（1）：85-90。 doi：10.1002 / jmv.24616。 2016年7月11日。
在拉米夫定和阿德福韦联合治疗后具有完全病毒学应答的拉米夫定耐药患者中拉米夫定终止后的病毒学应答的耐久性。
Kim MN1，Park JY2,3,4，Ahn SH5,6,7，Kim BK5,6,7，Kim SU5,6,7，Kim DY5,6,7，Han KH5,6,7。
作者信息

    摘要：目的探讨内皮功能障碍的临床特点。
    摘要：目的：探讨内科医学， [email protected]。
    3延世大学医学院胃肠病学研究所，韩国首尔。 [email protected]。
    4延世大学保健系统，韩国首尔长寿肝中心。 [email protected]。
    5，延世大学医学院内科，韩国首尔。
    6，延世大学医学院胃肠病学研究所，韩国首尔。
    7延世大学健康系统延世肝脏中心，韩国首尔。

抽象

我们调查拉米夫定（LAM）停止后LAM耐药慢性乙型肝炎（CHB）患者与LAM阿德福韦（ADV）联合治疗完全病毒学应答后的病毒学反应的耐久性。我们招募58例患者在LAM耐药CHB患者中切换至ADV单一疗法，其具有不可检测的病毒载量（<12IU / ml）和ADV加入组合治疗后至少6个月的正常丙氨酸氨基转移酶水平。病毒学复发被定义为在两次连续测量中测定的定量聚合酶链反应的HBV DNA检测超过20IU / ml。在中位40.9个月的随访期间（范围11.5-79.0个月），7例（12.1％）患者经历了病毒学复发。 3和5年时的病毒学复发的累积率分别为5.5％和22.4％。两个病人在病毒学复发期间具有升高的丙氨酸转氨酶。这7例病毒性复发患者转换为替诺福韦治疗后检测不到HBV DNA。在我们的研究中，在中位40.9个月随访期间，改用ADV单药治疗导致87.9％的患者持续的HBV DNA抑制。这种适应性的降低策略，从联合治疗转换到病毒学抑制CHB患者的稳定的肝脏疾病的单一疗法，可以降低成本负担和组合治疗的潜在有害影响的风险。 J.Med.Chem。 Virol。 89：85-90,2017。©2016 Wiley Periodicals，Inc.

©2016 Wiley Periodicals，Inc.
关键词：

抗病毒剂;乙型肝炎病毒;抵抗性

PMID：
    27357598
DOI：
    10.1002 / jmv.24616