改用替诺福韦与持续使用恩替卡韦治疗慢性乙型肝炎

StephenW

Virginia Schad, PharmD
June 15, 2018
Switching to Tenofovir vs Continuing Entecavir in Chronic Hepatitis B


Switching to tenofovir may be a better strategy to achieve optimal response in patients with chronic hepatitis B virus. Switching to tenofovir may be a better strategy to achieve optimal response in patients with chronic hepatitis B virus.

Switching to tenofovir disoproxil fumarate (TDF) is more efficacious than continuing entecavir (ETV) for achieving an optimal response in patients with chronic hepatitis B with a partial virologic response to ETV, according to a multicenter, open-label, randomized controlled study published in the Journal of Viral Hepatitis.

Chronic hepatitis B can progress to liver cirrhosis, hepatic failure, and hepatocellular carcinoma; therefore, the long-term treatment goal is to prevent progression through control of viral replication.

Korean guidelines suggest either that patients undergoing treatment with a drug with a high genetic barrier be switched to another drug with a high genetic barrier or that monotherapy be continued and the patient monitored for a virologic response at 3- to 6-month intervals.

No studies have directly compared the efficacy of switching from ETV to TDF with that of continuing ETV; therefore, researchers prospectively compared the efficacy of switching to TDF in 22 patients with chronic hepatitis B who had been receiving 0.5 mg ETV for more than 12 months but who still had detectable hepatitis B virus (HBV) DNA levels >60 IU/mL with 23 patients who continued treatment with ETV.

The researchers found that the virologic response rate (HBV DNA <20 IU/mL) was significantly higher in the TDF group than in the ETV group (55% vs 20%, respectively; P=.022) after 12 months of treatment. In addition, the reduction in HBV DNA was greater (−1.13 vs −0.67 log10 IU/mL; P =.024), and the mean HBV DNA was lower (1.54 vs 2.01 log10 IU/mL; P =.011), in the TDF group than in the ETV group.

"In conclusion, to achieve optimal response in [chronic hepatitis B] patients with [partial virologic response] to ETV, switching to TDF would be a better strategy" stated the authors, adding, "Appropriate modification of therapy would further improve the outcome of chronic HBV infection."

Disclosure

This study was supported by Gilead Sciences.


Reference

Yim HJ, Kim IH, Suh SJ, et al. Switching to tenofovir vs continuing entecavir for HBV with partial virologic response to entecavir: a randomized controlled trial [published online May 17, 2018]. J Viral Hepat. doi: 10.1111/jvh.12934

StephenW

Virginia Schad，PharmD
2018年6月15日
改用替诺福韦与持续使用恩替卡韦治疗慢性乙型肝炎


切换到替诺福韦可能是一个更好的策略，以达到慢性乙型肝炎病毒患者的最佳反应。切换到替诺福韦可能是一个更好的策略，以达到慢性乙型肝炎病毒患者的最佳反应。

根据一项多中心，开放标签，随机对照研究，替诺福韦酯替代延胡索酸酯（TDF）比持续使用恩替卡韦（ETV）更有效，以达到慢性乙型肝炎患者对ETV有部分病毒学应答的最佳反应。病毒性肝炎杂志。

慢性乙型肝炎可发展为肝硬化，肝功能衰竭和肝细胞癌;因此，长期治疗目标是通过控制病毒复制来预防进展。

韩国的指导方针表明，接受高遗传障碍药物治疗的患者应转为另一种高度遗传障碍的药物，或继续单药治疗，患者每3-6个月监测一次病毒学应答。

没有研究直接比较从ETV转换到TDF和继续ETV的疗效;因此，研究人员前瞻性比较了接受0.5mg ETV超过12个月但仍有可检测的乙型肝炎病毒（HBV）DNA水平> 60IU / mL的22名慢性乙型肝炎患者转换为TDF的疗效，其中23名继续接受ETV治疗的患者。

研究人员发现，治疗12个月后，TDF组病毒学应答率（HBV DNA <20 IU / mL）显着高于ETV组（55％比20％，P = 0.022）。此外，HBV DNA降低更多（-1.13 vs -0.67 log10 IU / mL; P = 0.024），平均HBV DNA较低（1.54 vs 2.01 log10 IU / mL; P = 0.011），在TDF组比ETV组要多。

“作为结论，为了在对ETV有[部分病毒学应答]的慢性乙型肝炎患者中获得最佳反应，切换到TDF将是一个更好的策略。”作者补充说，“适当修改疗法将进一步改善慢性HBV感染“。

泄露

这项研究得到了Gilead Sciences的支持。


参考

Yim HJ，Kim IH，Suh SJ等人转用替诺福韦与继续使用恩替卡韦治疗对恩替卡韦产生部分病毒学应答的HBV：一项随机对照试验[2018年5月17日在线发表]。 J Viral Hepat。 doi：10.1111 / jvh.12934

遥望曙光

恩替卡韦应答不佳的才会考虑转用替诺福韦吧？

StephenW

回复 遥望曙光 的帖子

是的

antiHBVren

只要使用ETV的战友，发现病毒不能转阴，建议换用TDF