肝硬化对恩替卡韦治疗慢性乙型肝炎的治疗反应没有影响

StephenW

Eur J Gastroenterol Hepatol. 2017 May 19. doi: 10.1097/MEG.0000000000000897. [Epub ahead of print]
Cirrhosis has no impact on therapeutic responses of entecavir for chronic hepatitis B.
Wang PC1, Wei TY, Tseng TC, Lin HH, Wang CC.
Author information

1    Department of Gastroenterology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, School of Medicine, Tzu Chi University, Hualien, Taiwan.

Abstract
OBJECTIVE:

As the efficacy of a direct antiviral agent is reduced in cirrhotic chronic hepatitis C patients, prolonged duration of treatment or addition of ribavirin is recommended to improve the rates of sustained virological response. However, the impact of cirrhosis on the efficacy of antiviral treatment for chronic hepatitis B (CHB) remained unclear.
PATIENTS AND METHODS:

This retrospective cohort study screened entecavir (ETV)-treated CHB patients in Taipei Tzu Chi Hospital from January 2007 till October 2014. The diagnosis of cirrhosis was made on the basis of clinical/imaging or histologic findings. The primary endpoints were hepatitis B e antigen (HBeAg) loss in HBeAg-positive patients and undetectable hepatitis B virus (HBV) DNA in the overall study population. Initial virological response is defined as undetectable HBV DNA at 1-year ETV treatment.
RESULTS:

A total of 381 (262 men; mean age: 49.6±12.9 years) CHB patients were recruited for the final analysis. Of these, 138 were cirrhotic. In 143 HBeAg-positive patients, there was no difference in the rates of 1- and 2-year HBeAg loss between cirrhotic and noncirrhotic patients (P=0.226 and 0.729, respectively). In the overall population, the rate of 1-year undetectable HBV DNA was higher in patients with cirrhosis than those without cirrhosis (76.1 vs. 64.2%, P=0.016). The rate of 2-year undetectable HBV DNA was not different between these two groups. Using multivariate logistic regression analysis, baseline HBV DNA levels (P=0.006) and HBeAg status (P=0.007), were associated with initial virological response, but not cirrhosis.
CONCLUSION:

Therapeutic responses of ETV are not decreased in cirrhotic CHB patients. Thus, cirrhotic CHB patients can be treated with ETV without the need for dose adjustment.

PMID:
    28538267
DOI:
    10.1097/MEG.0000000000000897

StephenW

Eur J Gastroenterol Hepatol。 2017年5月19. doi：10.1097 / MEG.0000000000000897。 [提前印刷]
肝硬化对恩替卡韦治疗慢性乙型肝炎的治疗反应没有影响
王PC1，魏TY，曾TC，林HH，王CC。
作者信息

1台湾慈济医院消化科，慈济医学基金，慈济大学医学院，台湾花莲。

抽象
目的：

由于直肠抗病毒药物在肝硬化慢性丙型肝炎患者中的疗效降低，建议长时间治疗或加入利巴韦林以提高持续的病毒学应答率。然而，肝硬化对抗病毒治疗对慢性乙型肝炎（CHB）疗效的影响尚不清楚。
患者和方法：

本回顾性队列研究于2007年1月至2014年10月期间在台北慈济医院筛查恩替卡韦（ETV）治疗的CHB患者。根据临床/影像学检查或组织学检查结果确定肝硬化。主要终点是HBeAg阳性患者的乙型肝炎e抗原（HBeAg）损失和总体研究人群中不可检测的乙型肝炎病毒（HBV）DNA。初步的病毒学应答定义为1年ETV治疗中不可检测的HBV DNA。
结果：

共招收381名（262名男性;平均年龄49.6±12.9岁）CHB患者进行最终分析。其中138例肝硬化。在143例HBeAg阳性患者中，肝硬化和非肝硬化患者1年和2年HBeAg损失率分别没有差异（P = 0.226和0.729）。在总体人群中，肝硬化患者1年无法检出HBV DNA的比率高于无肝硬化患者（76.1例，64.2％，P = 0.016）。两组之间2年无法检测HBV DNA的比例没有差异。使用多变量逻辑回归分析，基线HBV DNA水平（P = 0.006）和HBeAg状态（P = 0.007）与初始病毒学应答相关，而不是肝硬化。
结论：

在肝硬化CHB患者中，ETV的治疗反应不降低。因此，肝硬化CHB患者可以用ETV治疗，无需进行剂量调整。

结论：
    28538267
DOI：
    10.1097 / MEG.0000000000000897