停用拉米夫定治疗HBeAg阴性的慢性乙型肝炎：一项长期随访的

StephenW

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        Antivir Ther. 2017 Feb 27. doi: 10.3851/IMP3144. [Epub ahead of print]
Discontinuation of lamivudine treatment in HBeAg-negative chronic hepatitis B: a pilot study with long-term follow-up.Karakaya F1, Özer S1, Kalkan Ç1, Tüzün EA1, Çalışkan A1, Keskin O1, Kabaçam G1, Karatayli S2, Karatayli E2, Bozdayi AM2, Idilman R1,2, Yurdaydin C1,2.
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• 1Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey.
• 2Hepatology Institute, University of Ankara, Ankara, Turkey.
  

AbstractBACKGROUND: Finite treatment of HBeAg-negative chronic hepatitis B (CHB) with nucleos(t)ide analogs (NAs) is important in resource limited countries. Outcome of treatment discontinuation in patients on long-term lamivudine (LVD) was assessed in a single center observational pilot study in the current study.
METHODS: Non-cirrhotic patients on LVD for at least 5 years with undetectable HBV DNA on at least two consecutive assessments were offered to stop treatment. Biochemical, serological and virologic measures were determined at 3-6 month intervals after treatment discontinuation. Serum quantitative HBsAg was determined at treatment discontinuation and 5-6 years thereafter. NA treatment was re-instituted in patients with confirmed viral rebound defined as HBV DNA >20 000 IU/mL. Relapser patients were no longer followed but were re-assessed 6 years after treatment cessation.
RESULTS: LVD was discontinued in 23 patients. Eight patients relapsed within 1 year and NA treatment was restarted; 15 patients (65%) were non-relapsers. Thirteen of them were followed for at least 5 years. Two patients had undetectable HBVDNA throughout the follow-up period. In the rest, HBVDNA fluctuated at low levels. Two patients cleared HBsAg 24 and 36 months after stopping treatment. Quantitative HBsAg levels 5-7 years after treatment discontinuation were lower in non-relapser compared to relapser patients (1.21 IU/mL ± 0.98 vs. 2.71 ± 0.76, p=0.002). Of 8 relapser patients one patient had HBsAg levels less than 100 IU/mL compared to 11 out of 13 non-relapser patients (p=0.0022).
CONCLUSIONS: These data suggest that cessation of NA treatment is a viable option after a reasonable treatment duration in patients with HBeAg-negative CHB and that HBsAg clearance may become an achievable target in these patients.


PMID:28240596DOI:10.3851/IMP3144

StephenW

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Antivir治疗。 2017年2月27日。doi：10.3851 / IMP3144。 [打印前的电子版]
停用拉米夫定治疗HBeAg阴性的慢性乙型肝炎：一项长期随访的试点研究。
Karakaya F1，ÖzerS1，KalkanÇ1，TüzünEA1，ÇalışkanA1，Keskin O1，KabaçamG1，Karatayli S2，Karatayli E2，Bozdayi AM2，Idilman R1,2，Yurdaydin C1,2。
作者信息

    安卡拉大学医学院消化内科，安卡拉，土耳其。
    安卡拉大学，安卡拉，土耳其2Hepatology研究所。

抽象
背景：

用核苷（t）ide类似物（NA）有限治疗HBeAg阴性的慢性乙型肝炎（CHB）在资源有限的国家是重要的。在本研究中，在单中心观察性试验研究中评估长期拉米夫定（LVD）患者治疗停止的结果。
方法：

非肝硬化患者LVD至少5年，在至少两次连续评估中检测不到HBV DNA，停止治疗。在治疗停止后3-6个月的间隔测定生化，血清学和病毒学测量。在治疗停止和之后5-6年测定血清定量HBsAg。 NA治疗重新建立在确认病毒反弹的病人，定义为HBV DNA> 20 000 IU / mL。 Relapser患者不再跟踪，但在治疗停止后6年重新评估。
结果：

23例患者中断LVD。 8名患者在1年内复发，NA治疗重新开始; 15例（65％）为非复发者。其中13个被跟踪至少5年。两个病人在整个随访期间都检测不到HBVDNA。在其余的，HBVDNA波动在低水平。两个患者在停止治疗后24和36个月清除HBsAg。治疗停止后5-7年的定量HBsAg水平在非复发患者中低于复发患者（1.21IU / mL±0.98对2.71±0.76，p = 0.002）。在8名复发患者中，一名患者的HBsAg水平低于100 IU / mL，而13名非复发患者中有11名（p = 0.0022）。
结论：

这些数据表明，在HBeAg阴性CHB患者的合理治疗持续时间后停止NA治疗是可行的选择，并且HBsAg清除可能成为这些患者中可实现的靶标。

PMID：
    28240596
DOI：
    10.3851 / IMP3144