在病毒学抑制患者中从拉米夫定+阿德福韦转换为替诺福韦地

StephenW

Dig Liver Dis. 2017 Jan 16. pii: S1590-8658(17)30144-5. doi: 10.1016/j.dld.2017.01.140. [Epub ahead of print]
Long-term efficacy and safety of switching from lamivudine+adefovir to tenofovir disoproxil fumarate in virologically suppressed patients.Fasano M1, Maggi P2, Leone A2, Volpe A2, Fiore JR1, Angarano G2, Santantonio TA3.
Author information

• 1Clinic of Infectious Diseases, University of Foggia, Italy.
• 2Clinic of Infectious Diseases, University of Bari, Italy.
• 3Clinic of Infectious Diseases, University of Foggia, Italy. Electronic address: [email protected].
  

AbstractBACKGROUND AND AIM: Tenofovir disoproxil fumarate (TDF) is recommended as first-line monotherapy for nucleos(t)ide (NA)-naïve chronic hepatitis B (CHB) patients and as a second-line rescue therapy for NA-experienced patients with a previous treatment failure. However, data regarding the efficacy of TDF monotherapy in patients with lamivudine resistance (LAM-R) successfully treated with LAM+adefovir (ADV) are limited. Herein, the efficacy and safety of switching from LAM+ADV to TDF monotherapy in clinical practice have been evaluated.
METHODS: Sixty LAM-R HBeAg-negative CHB patients treated with ADV add-on therapy and stable viral suppression, were switched to TDF monotherapy and prospectively evaluated for virological response, liver and renal function, and bone mineral density.
RESULTS: During a median period of 57 months of TDF monotherapy, all patients maintained a virological response, four of whom cleared HBsAg (6.6%) and discontinued treatment. Monitoring of renal function showed no case of the Fanconi syndrome, no significant alterations of median serum creatinine, eGFR and phosphate levels, although a reduction of TDF dosage was required in five patients (8.3%). Despite the stable virological suppression, five cirrhotic patients and one CHB patient developed hepatocellular carcinoma.
CONCLUSIONS: Our results demonstrate the efficacy of switching to TDF monotherapy in virologically suppressed CHB patients receiving long-term LAM+ADV therapy, with a low rate of adverse events.

Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

KEYWORDS: Antiviral therapy; Chronic hepatitis B; Nucleos(t)ide analogues; Tenofovir

PMID:28179096DOI:10.1016/j.dld.2017.01.140

StephenW

Dig Liver Dis。 2017 Jan Jan。pii：S1590-8658（17）30144-5。 doi：10.1016 / j.dld.2017.01.140。 [打印前的电子版]
在病毒学抑制患者中从拉米夫定+阿德福韦转换为替诺福韦地索普西富马酸盐的长期功效和安全性。
Fasano M1，Maggi P2，Leone A2，Volpe A2，Fiore JR1，Angarano G2，Santantonio TA3。
作者信息

    1传染病诊所，福贾大学，意大利。
    2传染病诊所，巴里大学，意大利。
    3传染病诊所，福贾大学，意大利。电子地址：[email protected]。

抽象
背景和目的：

替诺福韦地索普西富马酸盐（TDF）被推荐作为核苷（t）ide（NA） - 慢性乙型肝炎（CHB）患者的一线单一疗法，并作为二线救援治疗NA先前治疗失败的NA患者。然而，关于TDF单药治疗拉米夫定耐药（LAM-R）成功治疗LAM +阿德福韦（ADV）的疗效的数据有限。本文中，评估了在临床实践中从LAM + ADV到TDF单药治疗的切换的功效和安全性。
方法：

使用ADV附加疗法和稳定的病毒抑制治疗的60名LAM-R HBeAg阴性CHB患者被转换到TDF单一疗法，并且预期地评价病毒学应答，肝和肾功能和骨矿物质密度。
结果：

在TDF单一疗法的中位期为57个月时，所有患者均维持病毒学应答，其中4例清除HBsAg（6.6％）并停止治疗。监测肾功能显示没有Fanconi综合征的病例，没有显着改变中值血清肌酐，eGFR和磷酸盐水平，虽然需要减少TDF剂量五个病人（8.3％）。尽管稳定的病毒抑制，五个肝硬化患者和一个CHB患者发展成肝细胞癌。
结论：

我们的研究结果表明切换到TDF单药治疗病毒性抑制CHB患者接受长期LAM + ADV治疗，低不良事件率的疗效。

版权所有©2017 Editrice Gastroenterologica Italiana S.r.l.发布者Elsevier Ltd.保留所有权利。
关键词：

抗病毒治疗;慢性乙型肝炎;核苷（t）ide类似物;替诺福韦

PMID：
    28179096
DOI：
    10.1016 / j.dld.2017.01.140

yelanglms

StephenW 发表于 2017-2-10 16:41
Dig Liver Dis。 2017 Jan Jan。pii：S1590-8658（17）30144-5。 doi：10.1016 / j.dld.2017.01.140。 [打 ...

这么多癌变啊？