15/10/02说明:此前论坛服务器频繁出错,现已更换服务器。今后论坛继续数据库备份,不备份上传附件。

肝胆相照论坛

 

 

肝胆相照论坛 论坛 学术讨论& HBV English 血清病毒载量预测停止治疗的患者的HBV发作 ...
查看: 476|回复: 1
go

血清病毒载量预测停止治疗的患者的HBV发作

Rank: 8Rank: 8

现金
62111 元 
精华
26 
帖子
30441 
注册时间
2009-10-5 
最后登录
2022-12-28 

才高八斗

发表于 2017-8-18 12:09 |显示全部帖子
Serum viral load predicts HBV flares in patients who cease therapy

Hsu YC, et al. J Gastroenterol Hepatol. 2017;doi:10.1111/jgh.13728.
August 17, 2017

Persistent or severe hepatitis followed virological relapse among patients who discontinued treatment with Baraclude for chronic hepatitis B, according to recently published data. Serum viral load at treatment cessation predicted clinical flares.

“It remains controversial whether [chronic hepatitis B] patients can safely discontinue [nucleos(t)ide analogues] before HBsAg loss. How to predict durable off-therapy remission has become the focus of intense research,” the researchers wrote. “Our study adds to current understanding about the risk and risk stratification of clinical hepatitis subsequent to virological relapse in [chronic HBV] patients who stop taking [Baraclude].”

The prospective study comprised 92 patients diagnosed with chronic HBV for more than 6 months, had been treated with Baraclude (entecavir, Bristol-Myers Squibb) for a minimum of 3 years, and were seronegative for both HBeAg and viral DNA at treatment cessation. The patients developed virological relapse over a mean follow-up of 12.6 months.

Fifty-two patients encountered clinical hepatitis with a cumulative incidence of 61% (95% CI, 49.9-72.3) at 2 years from treatment cessation and 37 patients developed persistent or severe hepatitis with a cumulative incidence of 53% (95% CI, 40.9-66.2) at 2 years.

The researchers found that serum viral load at the time of virological relapse was a significant risk factor for clinical hepatitis after adjusting for alanine aminotransferase (ALT; HR = 1.31 per log IU/mL; 95% CI, 1.07-1.6). They also observed that severity of viremia at relapse was an independent risk factor for subsequent persistent or severe hepatitis (HR = 1.63 per log IU/mL; 95% CI, 1.27-2.1), after adjusting for the effect of ALT at relapse and alpha-fetoprotein at treatment cessation.

The risk for both clinical hepatitis and persistent or severe hepatitis increased incrementally with serum viral load in a dose-dependent manner (P < .0001). Patients with HBV DNA higher than 100,000 IU/mL at virological relapse had a 2-year cumulative incidence of 89.7% (95% CI, 72.4-89.2) for clinical hepatitis compared with 51.3% (95% CI, 38.6-65.5) in those with viremia lower than 100,000 IU/mL.

Patients with viral load higher than 100,000 IU/mL similarly had a higher risk for developing persistent or severe hepatitis at a cumulative incidence of 88% (95% CI, 69.7-97.9) compared with 41.7% in those with a viral load less than 100,000 IU/mL (95% CI, 28.2-58.2).

“The major concern of stopping [nucleos(t)ide analogue] in [chronic HBV] patients is the risk of acute on chronic liver failure that may rapidly ensue after a severe bout of clinical flare,” the researchers wrote. “Based on our findings, retreatment should not be deferred in patients who relapse with a high viral load. Identification of this indicator helps to diminish the risk of persistent or severe clinical hepatitis.” – by Talitha Bennett

Disclosure: Hsu reports he received lecture fees from Bristol-Myers Squibb, Roche and Gilead Sciences. Please see the full study for the other researchers’ relevant financial disclosures.

Rank: 8Rank: 8

现金
62111 元 
精华
26 
帖子
30441 
注册时间
2009-10-5 
最后登录
2022-12-28 

才高八斗

发表于 2017-8-18 12:09 |显示全部帖子
血清病毒载量预测停止治疗的患者的HBV发作

许Y,等G胃肠肝炎2017; DOI:10.1111 / jgh.13728。
2017年8月17日

根据最近公布的数据,持续或严重的肝炎随着Baraclude治疗慢性乙型肝炎患者的病毒学复发。治疗停止时血清病毒载量预测临床发作。

“慢性乙型肝炎患者在HBsAg损失前可以安全地停止[核苷类似物]仍然存在争议。研究人员写道:如何预测持续的治疗后缓解已成为研究热点。 “我们的研究增加了目前对停止服用[Baraclude]的[慢性HBV]患者的病毒学复发后临床肝炎风险和风险分层的理解。

前瞻性研究包括92名诊断为慢性HBV超过6个月的患者,已接受Baraclude(恩替卡韦,布里斯托 - 迈尔斯·施贵宝)治疗至少3年,并且在治疗停止时均为HBeAg和病毒DNA血清阴性。患者发生病毒学复发,平均随访12.6个月。

五十二名患者遇到临床肝炎,治疗2年时累积发生率为61%(95%CI,49.9-72.3),37例发生持续性或重度肝炎,累积发生率为53%(95%CI为40.9 -66.2)。

研究人员发现,病毒学复发时血清病毒载量是调整丙氨酸氨基转移酶(ALT; HR = 1.31每log IU / mL; 95%CI,1.07-1.6)后临床肝炎的重要危险因素。他们还观察到,复发后病毒血症的严重程度是后续持续或严重肝炎的独立危险因素(HR = 1.63每log IU / mL; 95%CI,1.27-2.1),在调整ALT在复发和α后的作用 - 甲胎蛋白在治疗戒烟。

临床肝炎和持续性或重度肝炎的风险随着血清病毒载量呈剂量依赖性增加(P <0.0001)。 HBV DNA高于100,000 IU / mL的患者病毒性复发患者临床肝炎2年累积发生率为89.7%(95%CI,72.4-89.2),而51.3%(95%CI为38.6-65.5),其中病毒血症低于10万IU / mL。

病毒载量高于100,000 IU / mL的患者同样具有发生持续性或重度肝炎的风险较高,累积发生率为88%(95%CI,69.7-97.9),而病毒载量低于100,000的患者为41.7% IU / mL(95%CI,28.2-58.2)。

研究人员写道:“在[慢性HBV]患者中停止[核苷类似物]的主要问题是慢性肝衰竭的急性风险,可能在严重的临床发作后迅速发生。 “根据我们的研究结果,在病毒载量高的患者中不应推迟治疗。鉴定该指标有助于减少持续或严重的临床肝炎的风险。“ - 由Talitha Bennett

披露:许多报告他收到了布里斯托 - 迈尔斯·施贵宝,罗氏和吉利德科学的演讲费。请参阅其他研究人员相关财务披露的全面研究。
你需要登录后才可以回帖 登录 | 注册

肝胆相照论坛

GMT+8, 2024-3-29 21:13 , Processed in 0.014182 second(s), 11 queries , Gzip On.

Powered by Discuz! X1.5

© 2001-2010 Comsenz Inc.