与核苷（t）初始患者相比，替诺福韦在阿德福韦经历的慢性

StephenW

Clin Mol Hepatol. 2017 Feb 14. doi: 10.3350/cmh.2016.0060. [Epub ahead of print]
Tenofovir has inferior efficacy in adefovir-experienced chronic hepatitis B patients compared to nucleos(t)ide-naïve patients.Chung GE1, Cho EJ2, Lee JH2, Yoo JJ2,3, Lee M4, Cho Y2,5, Lee DH2,6, Kim HY7, Yu SJ2, Kim YJ2, Yoon JH2, Zoulim F8.
Author information

• 1Department of Internal Medicine, Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea.
• 2Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
• 3Department of Gastroenterology and Hepatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
• 4Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea.
• 5Department of Internal Medicine, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
• 6Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
• 7Department of Internal Medicine, Ewha Womans University School of Medicine Liver Center, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.
• 8INSERM Unité 1052, Cancer Research Center of Lyon, Hospices Civils de Lyon, Lyon University, Lyon, France.
  

AbstractBackground/Aims: A recent study reported that entecavir had inferior efficacy in nucleos(t)ide analogue (NA)-experienced chronic hepatitis B (CHB) patients compared to NA-naïve patients. We sought to compare the efficacy of tenofovir disoproxil fumarate (TDF) in NA-experienced and NA-naïve CHB patients.
Methods: We retrospectively enrolled 252 consecutive patients who had a serum hepatitis B virus (HBV) DNA level greater than 2,000 IU/mL at the initiation of TDF treatment and who received TDF for at least 6 months. Complete virologic suppression (CVS) was defined as undetectable serum HBV DNA. We generated a multivariate Cox proportional-hazard model to examine predictive factors that were independently associated with time to CVS.
Results: The mean age of patients was 48.2 years, and the cohort included 181 NA-naïve patients and 71 NA-experienced patients. The median duration of TDF treatment was 14.4 (interquartile range, 9.5-17.8) months. A total of 167 (92.3%) of 181 NA-naïve patients achieved CVS, and 60 (84.5%) of 71 NA-exposed patients achieved CVS. Forty-nine (89.1%) of 55 patients who previously took an NA aside from adefovir and 11 (68.8%) of 16 adefovir-experienced patients achieved CVS. In multivariable analysis, previous adefovir exposure significantly influenced time to CVS (hazard ratio, 0.37; 95% confidence interval, 0.19-0.72; P=0.003), after adjusting for HBeAg positivity, baseline HBV DNA level and cirrhosis.
Conclusions: Tenofovir had inferior efficacy in adefovir-experienced CHB patients compared to NA-naïve patients. The response of patients with previous adefovir exposure to TDF monotherapy should be monitored closely.


KEYWORDS: Adefovir; Hepatitis B; Tenofovir

PMID:28190329DOI:10.3350/cmh.2016.0060

StephenW

Clin Mol Hepatol。 2017年2月14日。doi：10.3350 / cmh.2016.0060。 [印刷前电子版]
与核苷（t）初始患者相比，替诺福韦在阿德福韦经历的慢性乙型肝炎患者中具有较差的功效。
Chung GE1，Cho EJ2，Lee JH2，Yoo JJ2,3，Lee M4，Cho Y2.5，Lee DH2,6，Kim HY7，Yu SJ2，Kim YJ2，Yoon JH2，Zoulim F8。
作者信息

    1韩国首尔国立大学医院江南医疗中心医疗研究所内科学科。
    2韩国首尔国立大学医学院内科与肝脏研究所。
    摘要：目的探讨肝硬化患者肝硬化的临床特点。
    韩国春川国立大学医院内科。
    5，韩国首尔CHA大学CHA江南医学中心内科。
    6首尔市政府内科学部首尔国立大学Boramae医疗中心，韩国首尔。
    7梨花女子大学医学院内科，梨花女子大学Mokdong医院，梨花女子大学医学院，韩国首尔。
    8INSERMUnité1052，里昂癌症研究中心，里昂大学医院里昂，法国里昂。

抽象
背景/目的：

最近的一项研究报告，恩替卡韦在核苷类似物（NA） - 经验的慢性乙型肝炎（CHB）患者中的疗效相对于未接受NA的患者较差。我们试图比较替诺福韦disoproxil延胡索酸（TDF）在NA-经历和NA-天真的CHB患者的疗效。
方法：

我们回顾性登记了252名在TDF治疗开始时血清乙型肝炎病毒（HBV）DNA水平大于2000 IU / mL且接受TDF至少6个月的连续患者。完全病毒学抑制（CVS）定义为不可检测的血清HBV DNA。我们生成多变量Cox比例风险模型来检查与CVS时间独立相关的预测因素。
结果：

患者的平均年龄为48.2岁，该队列包括181名未接受NA的患者和71名NA-经历的患者。 TDF治疗的中位持续时间为14.4（四分位数范围，9.5-17.8）个月。 181名未接受NA的患者中有167名（92.3％）获得CVS，71名NA受试者中有60名（84.5％）获得CVS。 55例患者中有49例（89.1％）先前从阿德福韦服用NA，16例阿德福韦耐药患者中有11例（68.8％）实现CVS。在多变量分析中，在调整HBeAg阳性，基线HBV DNA水平和肝硬化后，先前的阿德福韦暴露显着影响到CVS的时间（风险比，0.37; 95％置信区间，0.19-0.72; P = 0.003）
结论：

与不含NA的患者相比，替诺福韦在阿德福韦经历的CHB患者中具有较差的功效。应该密切监测先前阿德福韦暴露于TDF单药治疗的患者的反应。
关键词：

阿德福韦;乙型肝炎;替诺福韦

PMID：
    28190329
DOI：
    10.3350 / cmh.2016.0060