乙肝治疗：干扰素是否还有作用？

StephenW

Liver Int. 2018 Feb;38 Suppl 1:79-83. doi: 10.1111/liv.13635.
Treatment of hepatitis B: Is there still a role for interferon?Viganò M1, Grossi G2, Loglio A2, Lampertico P2.
Author information
1Hepatology Division, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy.2CRC "A.M. e A. Migliavacca" Center for the Study of Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy.

AbstractThe treatment of chronic hepatitis B (CHB) patients is based on monotherapy with pegylated-interferon (Peg-IFN) or with one of the three most potent nucleot(s)ide analogues (NUCs) with the best resistance profiles, i.e. entecavir (ETV), tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF). Long-term NUCs treatment can achieve virological suppression in almost all patients. However, this requires lifelong therapy, is costly and the rate of hepatitis B surface antigen (HBsAg) seroclearance is low. A one-year course of Peg-IFN has the advantage of providing immune-mediated control of the hepatitis B virus (HBV) infection, the possibility of achieving a sustained off-treatment response in nearly 30% of the patients and ultimately, HBsAg loss in approximately 30%-50% of the latter patients during long-term off treatment follow-up. However, the major limitations to the extensive use of this treatment are the need for parenteral therapy and clinical and laboratory monitoring, the side-effects profile and contraindications in certain patients and the limited effectiveness in a large proportion of patients. Nevertheless, the cost-effectiveness of Peg-IFN can be significantly increased by careful patient selection based upon baseline alanine aminotransferase (ALT), HBV DNA levels, viral genotype, host genetic variants and especially by applying early on-treatment stopping rules based upon HBsAg kinetics. Recently, because of the different mechanisms of action of Peg-IFN and NUCs, the strategy of "adding-on" or "switching to" Peg-IFN in patients being treated with NUCs to accelerate the decline in HBsAg and enhance HBsAg seroclearance rates, has provided interesting results.


KEYWORDS: antiviral treatment; hepatitis B virus; interferon

PMID:29427498DOI:10.1111/liv.13635

StephenW

肝脏国际。 2018年2月; 38增刊1：79-83。 doi：10.1111 / liv.13635。
乙肝治疗：干扰素是否还有作用？
ViganòM1，Grossi G2，Loglio A2，Lampertico P2。
作者信息

1
    意大利米兰Universitàdegli Studi di Milano，意大利Ospedale San Giuseppe医院肝病科。
2
    CRC“A.M. e A. Migliavacca”肝病研究中心，胃肠病学和肝病学部，Fondazione IRCCSCàGranda Ospedale Maggiore Policlinico，意大利米兰大学米兰大学。

抽象

慢性乙型肝炎（CHB）患者的治疗基于聚乙二醇化干扰素（Peg-IFN）或三种最有效核苷酸类似物（NUCs）中具有最佳耐药谱之一的单一疗法，即恩替卡韦（ETV） ），富马酸替诺福韦二吡呋酯（TDF）和替诺福韦艾拉酚胺（TAF）。几乎所有患者的长期NUCs治疗都可以达到病毒学抑制。然而，这需要终身治疗，费用昂贵，乙型肝炎表面抗原（HBsAg）血清清除率较低。 Peg-IFN的一年疗程具有免疫介导控制乙型肝炎病毒（HBV）感染的优势，在近30％的患者中实现持续的治疗不良反应的可能性，并最终导致HBsAg消失约30％-50％的患者在长期停药后随访中。然而，广泛使用这种治疗的主要局限性是需要肠外治疗和临床和实验室监测，某些患者的副作用和禁忌症以及大部分患者的有效性有限。然而，通过基于基线丙氨酸转氨酶（ALT），HBV DNA水平，病毒基因型，宿主遗传变异体以及特别是通过应用基于HBsAg的早期治疗停止规则的仔细患者选择，Peg-IFN的成本效益可以显着增加动力学。最近，由于Peg-IFN和NUCs的作用机制不同，在接受NUCs治疗的患者中，“添加”或“转换”Peg-IFN的策略加速了HBsAg的下降，增加了HBsAg血清清除率，提供了有趣的结果。
关键词：

抗病毒治疗;乙肝病毒;干扰素

结论：
    29427498
DOI：
    10.1111 / liv.13635

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