慢性乙型肝炎抗病毒药物治疗

StephenW

Gut Liver. 2017 Feb 13. doi: 10.5009/gnl15562. [Epub ahead of print]
Management of Antiviral Resistance in Chronic Hepatitis B.Lim YS1.
Author information

• 1Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  

AbstractThe primary goal of therapy for chronic hepatitis B (CHB) is to prevent liver disease progression. Hepatitis B surface antigen (HBsAg) seroclearance or seroconversion is regarded as an optimal endpoint to discontinue treatment. However, HBsAg seroclearance occurs very rarely with nucleos(t)ide analog (NUC) treatment, and long-term, almost indefinite, NUC treatment is required for the majority of patients. In patients with drug-resistant hepatitis B virus (HBV), a combination of tenofovir disoproxil fumarate (TDF) and entecavir (ETV), which is currently regarded as the strongest combination therapy against HBV, would be potentially safe to prevent the emergence of additional HBV resistance mutations. However, long-term tolerance data are lacking, and cost may be an issue for combination therapies. Several recent, well-designed, randomized controlled trials have shown that TDF monotherapy provides similar antiviral efficacy compared with the combination of TDF and ETV. Furthermore, no additional HBV resistance mutations emerged during TDF monotherapy for up to 96 weeks. Considering a comparable antiviral efficacy, extremely low risk of TDF-resistance, lower cost, and better safety potential, TDF monotherapy would be a reasonable choice for the treatment of drug-resistant patients with CHB.


KEYWORDS: Adefovir; Entecavir; Lamivudine; Monotherapy; Tenofovir

PMID:28183162DOI:10.5009/gnl15562

StephenW

肠肝。 2017年2月13日。doi：10.5009 / gnl15562。 [印刷前电子版]
慢性乙型肝炎抗病毒药物治疗
Lim YS1。
作者信息

    摘要：目的了解ls山医科大学医学中心肝内科，肝脏中心，韩国首尔市。

抽象

慢性乙型肝炎（CHB）治疗的主要目标是预防肝病进展。乙型肝炎表面抗原（HBsAg）seroclearance或血清转换被认为是停止治疗的最佳终点。然而，HBsAg血清清除非常罕见与nucleos（t）ide模拟（NUC）治疗，并且长期，几乎不确定，NUC治疗是大多数患者需要。在耐药性乙型肝炎病毒（HBV）的患者中，替诺福韦酯的延胡索酸酯（TDF）和恩替卡韦（ETV）的组合，其目前被认为是针对HBV的最强组合疗法，将潜在地安全以防止出现另外的HBV耐药突变。然而，缺乏长期耐受性数据，并且成本可能是组合疗法的问题。几个最近的，精心设计的随机对照试验已经显示，与TDF和ETV的组合相比，TDF单一疗法提供相似的抗病毒功效。此外，没有额外的HBV耐药突变出现在TDF单药治疗达96周。考虑到可比较的抗病毒功效，极低的TDF耐药风险，更低的成本和更好的安全潜力，TDF单药治疗将是治疗耐药性CHB患者的合理选择。
关键词：

阿德福韦;恩替卡韦拉米夫定;单药治疗;替诺福韦

PMID：
    28183162
DOI：
    10.5009 / gnl15562