日本慢性乙型肝炎患者从恩替卡韦早期转换为聚乙二醇化干

StephenW

Hepatol Res. 2018 Jan 4. doi: 10.1111/hepr.13050. [Epub ahead of print]
Sequential therapy involving an early switch from entecavir to pegylated interferon-α in Japanese patients with chronic hepatitis B.Enomoto M1, Nishiguchi S2, Tamori A1, Kozuka R1, Fujii H1, Uchida-Kobayashi S1, Fukunishi S3, Tsuda Y3, Higuchi K3, Saito M2, Enomoto H2, Kawada N1.
Author information
1Department of Hepatology, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.2Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.3Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan.

AbstractAIM: The optimal combination of the two currently available agents with different mechanisms of action, a nucleos(t)ide analog and pegylated interferon-α (PegIFNα), must be determined to improve treatment of chronic hepatitis B.
METHODS: In this study, 24 patients with chronic hepatitis B (14 hepatitis B e-antigen [HBeAg]-positive and 10 HBeAg-negative) received entecavir for 36-52 weeks, followed by entecavir plus PegIFNα-2a for 4 weeks and finally by PegIFNα-2a alone for 44 weeks.
RESULTS: A sustained biochemical, virological, and serological response was obtained in 7/24 (29%) patients at 48 weeks post-treatment (2/14 [14%] in HBeAg-positive vs. 5/10 [50%] in HBeAg-negative patients, P = 0.085). At baseline, patients with a sustained response had a significantly lower γ-glutamyl transferase level (P = 0.0023), a lower aspartate aminotransferase-to-platelet ratio index (P = 0.049) and a lower α-fetoprotein level (P = 0.042) than those without a sustained response. The decline in hepatitis B surface antigen (HBsAg) levels during the first 24 weeks of PegIFNα-2a treatment in patients with a sustained response was greater than that in patients without (P = 0.017). HBsAg seroclearance was achieved in two patients (8.3%): one HBeAg-positive and one HBeAg-negative patient.
CONCLUSION: The outcomes of sequential therapy involving an early switch from entecavir to PegIFNα-2a were unsatisfactory in Japanese patients with chronic hepatitis B. In addition to viral factors, host metabolic characteristics and liver fibrosis/tumor markers can be used for prediction of a sustained response to therapy, but accurate prediction of the therapeutic response is difficult.


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KEYWORDS: Combination; HBV; IFN; genotype C; nucleoside analog

PMID:29314465DOI:10.1111/hepr.13050

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StephenW

Hepatol Res。 2018年1月4日，doi：10.1111 / hepr.13050。 [电子版提前打印]
日本慢性乙型肝炎患者从恩替卡韦早期转换为聚乙二醇化干扰素-α的序贯疗法
Enomoto M1，西口S2，Tamori A1，Kozuka R1，Fujii H1，内田小林S1，Fukunishi S3，Tsuda Y3，Higuchi K3，Saito M2，Enomoto H2，Kawada N1。
作者信息

1
    日本大阪市阿倍野区朝日町1-4-3大阪市立大学医学部肝病科
2
    日本西宫兵库医科大学内科学系。
3
    日本大阪府大阪医科大学第二内科。

抽象
目标：

必须确定两种现有的具有不同作用机制的药物，核苷（酸）类似物和聚乙二醇化干扰素-α（PegIFNα）的最佳组合，以改善慢性乙型肝炎的治疗。
方法：

本研究中，24例慢性乙型肝炎患者（14例乙型肝炎e抗原[HBeAg]阳性和10例HBeAg阴性）接受恩替卡韦治疗36-52周，恩替卡韦联合PegIFNα-2a治疗4周，最后接受PegIFNα治疗-2a单独44周。
结果：

治疗48周后，7/24（29％）患者获得持续的生化，病毒学和血清学应答（HBeAg阳性2/14 [14％]，HBeAg阳性5/10 [50％阴性患者，P = 0.085）。在基线时，持续反应患者γ-谷氨酰转移酶水平显着降低（P = 0.0023），天冬氨酸转氨酶 - 血小板比值下降（P = 0.049），甲胎蛋白水平下降（P = 0.042）比那些没有持续的回应。在PegIFNα-2a治疗持续反应患者的前24周内，乙肝表面抗原（HBsAg）水平的下降大于未患有（P = 0.017）的患者。 HBsAg血清清除率达到了两个病人（8.3％）：一个HBeAg阳性和一个HBeAg阴性患者。
结论：

在日本慢性乙型肝炎患者中，涉及从恩替卡韦到PegIFNα-2a的早期转换的序贯疗法的结果是不令人满意的。除了病毒因子，宿主代谢特征和肝纤维化/肿瘤标志物可用于预测对治疗，但治疗反应的准确预测是困难的。

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关键词：

组合; HBV; IFN;基因型C;核苷类似物

结论：
    29314465
DOI：
    10.1111 / hepr.13050

antiHBVren

嗯，关键是治疗反应的准确预测；
假如能够预测的话，就能够准确挑出适合的人群啦