慢性乙型肝炎患者聚乙二醇干扰素和核苷酸联合治疗后HBsAg损

StephenW

J Viral Hepat. 2017 Jun 20. doi: 10.1111/jvh.12738. [Epub ahead of print]
HBsAg loss after peginterferon and nucleotide combination treatment in chronic hepatitis B patients: 5 years of follow-up.Stelma F1, van der Ree MH1, Jansen L1, Peters MW1, Janssen HLA2,3, Zaaijer HL4, Takkenberg RB1, Reesink HW1.
Author information
1Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.2Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.3Toronto Centre for Liver Disease, Toronto Western & General Hospital, University Health Network, Toronto, Canada.4Department of Clinical Virology, Academic Medical Center, Amsterdam, The Netherlands.

AbstractBACKGROUND AND AIMS: Combining peginterferon alfa-2a (pegIFN) with a nucleotide analogue can result in higher rates of HBsAg loss than either therapy given alone. Here we investigated the durability of the response to combination therapy in chronic hepatitis B (CHB) patients after 5 years of follow-up.
METHODS: In the initial study, 92 CHB patients (44 HBeAg positive, 48 HBeAg negative) with HBV DNA > 100,000 c/mL (~20,000 IU/mL) and active hepatitis were treated for 48 weeks with pegIFN 180 μg/week and 10 mg adefovir dipivoxil daily. For the long term follow-up study, patients were followed-up for 5 years after the end of treatment. At year 5, 70 (32 HBeAg positive, 38 HBeAg negative) patients remained in the study.
RESULTS: At year 5, 19% (6/32) of HBeAg positive patients and 16% (6/38) of HBeAg negative patients lost HBsAg, and no HBsAg sero-reversion was observed. The 5-year cumulative Kaplan-Meier estimate for HBsAg loss was 17.2% for HBeAg positive patients and 19.3% for HBeAg negative patients. 14/16 patients who lost HBsAg at any time point during follow-up developed anti-HBs antibodies (>10 IU/L). At year 5, in total 63% (20/32) of HBeAg positive and 71% (27/38) of HBeAg negative patients were retreated with nucleos(t)ide analogues during follow-up. The cumulative Kaplan-Meier estimate for retreatment was 60% of patients at year 5.
CONCLUSION: At year 5 of follow-up, 18% of CHB patients treated with pegIFN/ nucleotide analogue combination therapy had durable HBsAg loss and 88% of these had developed anti-HBs antibodies. This article is protected by copyright. All rights reserved.


This article is protected by copyright. All rights reserved.



KEYWORDS: Hepatitis B virus; combination treatment; functional cure; long term follow-up; nucleotide analogue; peginterferon; quantitative HBsAg

PMID:28632898DOI:10.1111/jvh.12738

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StephenW

J病毒肝2017年6月20日。doi：10.1111 / jvh.12738。 [提前印刷]
慢性乙型肝炎患者聚乙二醇干扰素和核苷酸联合治疗后HBsAg损失：5年随访。
Stelma F1，van der Ree MH1，Jansen L1，Peters MW1，Janssen HLA2,3，Zaaijer HL4，Takkenberg RB1，Reesink HW1。
作者信息

1
    荷兰阿姆斯特丹学术医学中心消化内科和肝病学系。
2
    荷兰鹿特丹伊拉斯姆斯医学中心消化内科和肝病学系。
3
    多伦多多伦多肝病中心多伦多西部综合医院，加拿大多伦多大学健康网络。
4
    荷兰阿姆斯特丹医学中心临床病毒学系。

抽象
背景与目的：

将聚乙二醇化干扰素α-2a（pegIFN）与核苷酸类似物相结合可导致比单独使用的治疗更高的HBsAg损失率。在这里，我们调查了5年随访后慢性乙型肝炎（CHB）患者联合治疗反应的耐久性。
方法：

在初始研究中，使用pegIFN 180μg/周和10mg阿德福韦治疗92例HBV DNA> 100,000 c / mL（〜20,000 IU / mL）和活动性肝炎的CHB患者（44例HBeAg阳性，48例HBeAg阴性）治疗48周每日一次。对于长期随访研究，治疗结束后患者随访5年。在第5年，70例（32例HBeAg阳性，38例HBeAg阴性）患者仍在研究中。
结果：

在第5年，HBeAg阳性患者的19％（6/32）和HBeAg阴性患者的16％（6/38）失去了HBsAg，没有观察到HBsAg血清反转。 HBeAg阳性患者HBsAg损失的5年累积Kaplan-Meier估计为17.2％，HBeAg阴性患者为19.3％。在随访期间随机时间点，失去HBsAg的14/16例患者发生抗HBs抗体（> 10IU / L）。在第5年，HBeAg阳性患者总共63％（20/32），HBeAg阴性患者71％（27/38）在随访期间用核苷类似物撤回。再次治疗累积的Kaplan-Meier评估是第5年患者的60％。
结论：

在随访5年时，用pegIFN /核苷酸类似物联合治疗的CHB患者中有18％具有持久的HBsAg损失，88％的患者已经发展出抗HBs抗体。本文受版权保护。版权所有。

本文受版权保护。版权所有。
关键词：

乙型肝炎病毒联合治疗功能治疗长期随访;核苷酸类似物;聚乙二醇化干扰素;定量HBsAg

结论：
    28632898
DOI：
    10.1111 / jvh.12738