长期治疗核苷（t）ide类似物的治疗初治患者慢性乙型肝炎的

StephenW

Curr Med Res Opin. 2016 Nov 24:1-32. [Epub ahead of print]
Benefits of long-term therapy with nucleos(t)ide analogues in treatment-naïve patients with chronic hepatitis B.Wei L1, Kao JH2.
Author information

• 1a Peking University People's Hospital, Peking Hepatology Institute , Beijing , China.
• 2b National Taiwan University Hospital , Taipei , Taiwan.
  

AbstractOBJECTIVE: To assess the benefits of long-term nucleos(t)ide analogue (NA) therapy in reducing the severity and progression of liver disease in treatment-naïve patients with chronic hepatitis B (CHB).
SCOPE: As complications of CHB, such as hepatic decompensation and hepatocellular carcinoma (HCC), take a long time to develop in patients with less advanced disease, the long-term benefits of NA therapy in such patients are more difficult to prove than short- or medium-term benefits. Thus, the recent literature was reviewed to evaluate the impact of NA therapy on the long-term outcomes of treatment-naïve CHB patients.
METHODS: A literature search of the MEDLINE/PUBMED database was undertaken to identify studies published since 2010 of the long-term use of NAs with high potency and low drug resistance profiles in treatment-naïve CHB patients. A total of 22 studies were identified, many of which were retrospective analyses or case-control studies, as well as 3 meta-analyses and 1 systematic review.
RESULTS: Analysis of the retrieved studies showed that long-term NA therapy in treatment-naïve CHB patients did prevent or delay the occurrence of complications, including hepatic decompensation, HCC, and liver-related death, in comparison with no treatment. However, it did not completely eliminate the risk of these complications, particularly in those with cirrhosis. Although long-term NA therapy improved the clinical status of patients with decompensated cirrhosis, the risk of cirrhotic complications including HCC, liver transplantation, liver-related mortality remained significant in comparison with those with compensated cirrhosis.
CONCLUSIONS: Long-term administration is generally advised in all CHB patients treated with NAs because of the high rates of virological and clinical relapse after stopping therapy. The findings of this analysis lend support to the choice of highly potent agents with a low drug resistance profile to maximize viral suppression in CHB patients and halt or delay progression to end-stage liver disease.


KEYWORDS: Chronic hepatitis B; Long-term benefits; Long-term safety; Nucleoside analogues; Nucleotide analogues; Outcomes

PMID:27882776DOI:10.1080/03007995.2016.1264932

StephenW

Curr Med Res Opin。 2016 Nov 24：1-32。 [打印前的电子版]
长期治疗核苷（t）ide类似物的治疗初治患者慢性乙型肝炎的好处。
Wei L1，Kao JH2。
作者信息

    1a北京大学人民医院，北京肝病研究所，北京，中国。
    2b台湾大学医院，台北，台湾。

抽象
目的：

评估长期核苷类似物（NA）治疗在治疗慢性乙型肝炎（CHB）的初治患者中降低肝脏疾病的严重性和进展的益处。
范围：

由于慢性乙型肝炎的并发症，如肝失代偿和肝细胞癌（HCC），在晚期疾病患者中需要很长时间才能发展，所以在这种患者中NA治疗的长期益处比短期或中期 - 终结福利。因此，最近的文献审查，以评估NA治疗对未治疗CHB患者的长期结果的影响。
方法：

进行了MEDLINE / PUBMED数据库的文献检索，以鉴定自2010年以来发表的长期使用具有高效力和低耐药性特征的NAs的研究在未治疗的CHB患者中的研究。共确定了22项研究，其中许多是回顾性分析或病例对照研究，以及3项荟萃分析和1项系统评价。
结果：

检索研究的分析表明，长期NA治疗在治疗初始CHB患者确实预防或延迟并发症的发生，包括肝失代偿，HCC和肝相关死亡，与没有治疗相比。然而，它没有完全消除这些并发症的风险，特别是在那些与肝硬化。虽然长期NA治疗改善了失代偿性肝硬化患者的临床状态，但肝硬化并发症（包括肝癌，肝移植，肝相关死亡）的风险与补偿性肝硬化患者相比仍然显着。
结论：

由于在停止治疗后病毒学和临床复发的高比率，所以在用NA治疗的所有CHB患者中通常建议长期给药。该分析的发现支持选择具有低耐药性特征的高效药物，以最大化CHB患者中的病毒抑制，并且停止或延缓进展为终末期肝病。
关键词：

慢性乙型肝炎;长期福利;长期安全;核苷类似物;核苷酸类似物;结果

PMID：
    27882776
DOI：
    10.1080 / 03007995.2016.1264932