NUH通过在新的试验中停止药物治疗乙型肝炎患者

StephenW

Singapore
NUH cures patient of Hepatitis B by stopping medication in new trial

Read more at https://www.channelnewsasia.com/ ... tion-trial-11619346
SINGAPORE: Mr Arfan Awaloeddin was suffering from Hepatitis B for about 30 years, but in May this year, he was cured.

All he had to do was stop taking his medication.

The 49-year-old Indonesian is part of a National University Hospital (NUH) study that seeks to find out if Hepatitis B patients carrying a low amount of the markers of the viral infection have the best chances of being cured by stopping medication.

Hepatitis B is a viral infection that affects the liver and was estimated to have been present in 180,000 people in Singapore in 2010, according to the latest figures available.

Of the 23 people enrolled in the study that started in January, Mr Arfan is the first to be cured. The majority of them are men.

Mr Arfan was diagnosed with the disease in 1992 or 1993 in his home country, and started getting treatment in Singapore in 1996.

Speaking to the media at a sharing session at NUH on Wednesday (Jun 12), Mr Arfan said that he was initially scared to stop his medication.

"I stopped medication on my own without asking my doctor in around 2000. I stopped for two to three months. I felt unwell, and after that I had to take medication again," he said.

But he was reassured when his doctor, senior consultant in the Division of Gastroenterology & Hepatology, Professor Lim Seng Gee, told him he would be monitored.

Mr Arfan, who owns a hospital in Indonesia, said his father also suffered from Hepatitis B for 10 years before dying of liver cirrhosis in 2005. His three children, however, have been vaccinated against the disease.

It is a new life now for Mr Arfan.

I feel good. I don't have to spend money, I don't have to take medication every morning. I feel free," he said. He was spending about S$4,000 annually on his condition for consultation and medication, he said .

Mr Arfan will be monitored monthly for the first year, in the three-year study.

HOW STOPPING MEDICATION WORKS

Typically, chronic Hepatitis B patients have to be on long-term medication, which could mean taking tablets daily.

Prof Lim, the lead of the study, told the media said that when the medication is stopped, the virus will return. The patient’s immune system will then work to beat the virus.

The virus becomes something new to the body although it has carried it because while the patient was on medication, the body did not recognise the virus as foreign, he explained.

"When you stop treatment, suddenly, the body realises the virus is foreign, attacks it and clears it That’s what we think is the mechanism," said Prof Lim.

When asked if that means they did not need therapy to start with, he said no.

Professor Lim Seng Gee, a senior consultant in NUH who is leading a study on stopping medication to cure Hepatitis B and Mr Arfan Awaloeddin, the patient to be cured. (Photo: Jalelah Abu Baker)

"We can’t say that, because originally, they were started on treatment because they needed it. But after 10 years, 20 years of treatment, is it time to stop? That really is the question," he said.

How the immune system is able to clear the virus when it was not able to before is something that researchers are still trying to find out, he said.

Studies overseas have also shown that stopping medication cures Hepatitis B, but these did not focus on the amount of infection markers as a factor to find out which patients would benefit most from stopping medication, Prof Lim said.

The trial in Singapore is the only one that is targeted at patients with low levels of infection markers.

MINORITY WILL QUALIFY FOR STUDY

In order to qualify for the study here, patients have to fulfil three criteria.

Their infection markers have to be below the level of 100, they cannot have liver cirrhosis and they have to be on oral medication, said Prof Lim. Mr Arfan's infection marker level was just two, much lower than the cutoff of 100, when he was Enrolled.

Typically, patients have levels that go into the thousands.

While it is not known how many patients have such levels of markers, Prof Lim said it would be a minority who would qualify for it.

The cutoff was based on other studies. Testing for the level of infection markers is relatively new, quite expensive and not in routine use, but patients can get tested for free as part of the study at NUH, Prof Lim said.

"We do not know how common it is, so I would encourage patients to go and get it tested," he said.

The study, which will also start in Singapore General Hospital, Tan Tock Seng Hospital and Changi General Hospital, received S$1.5 million in funding from the National Medical Research Council.

It will aim to enrol 150 patients. Of these, 50 will continue taking their tablets, so that the effectiveness of stopping medication can be compared against them.
Source: CNA/ja(hm)

StephenW

新加坡
NUH通过在新的试验中停止药物治疗乙型肝炎患者

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新加坡：Arfan Awaloeddin先生患乙型肝炎约30年，但今年5月，他治愈了。

他所要做的只是停止服药。

这名49岁的印度尼西亚人是国立大学医院（NUH）研究的一部分，该研究试图找出携带少量病毒感染标志物的乙型肝炎患者是否有最好的机会通过停止药物治愈。

根据现有的最新数据，乙型肝炎是一种影响肝脏的病毒感染，估计2010年新加坡有180,000人。

在1月份开始的研究中，参加研究的23人中，Arfan先生是第一个被治愈的人。他们大多数是男性。

Arfan先生于1992年或1993年在其祖国被诊断患有该病，并于1996年开始在新加坡接受治疗。

Arfan先生于周三（6月12日）在NUH的分享会上对媒体说，他最初害怕停止服药。

“我在2000年左右没有询问我的医生就停止了自己的药物治疗。我停了两到三个月。我感到身体不适，之后我不得不再服用药物，”他说。

但当他的医生，消化内科和肝病学部的高级顾问Lim Seng Gee教授告诉他，他会受到监控时，他感到很放心。

在印度尼西亚拥有一家医院的Arfan先生说，他的父亲在2005年因肝硬化死亡之前也患有乙型肝炎10年。然而，他的三个孩子已经接种了这种疾病的疫苗。

对于阿凡先生来说，这是一种新的生活。

我感觉很好。我不需要花钱，每天早上我都不需要服用药物。我觉得自由，“他说。他说，他每年花费大约4,000新元用于咨询和用药。

在这项为期三年的研究中，Arfan先生将在第一年每月进行一次监测。

如何停止药物治疗

通常，慢性乙型肝炎患者必须接受长期服药，这可能意味着每天服用片剂。

该研究的负责人林教授告诉媒体说，当停药时，病毒就会复发。然后患者的免疫系统将起到击败病毒的作用。

他解释说，这种病毒成为身体的新病毒，虽然它携带它，因为当病人服用药物时，身体并不认为这种病毒是外来病毒。

“当你停止治疗时，突然，身体意识到病毒是外来的，攻击它并清除它。这就是我们认为的机制，”林教授说。

当被问及这是否意味着他们不需要治疗时，他说没有。

NUH的高级顾问Lim Seng Gee教授正在领导一项关于停止治疗乙型肝炎药物的研究，以及要治愈的患者Arfan Awaloeddin先生。 （照片：Jalelah Abu Baker）

“我们不能这么说，因为最初他们因为需要而开始接受治疗。但经过10年，20年的治疗，是时候停止了吗？这真是个问题，”他说。

他说，如果免疫系统能够在以前无法清除病毒的情况下，研究人员仍在努力寻找它。

海外研究还表明，停止服用治疗乙型肝炎，但这些并未关注感染标记物的数量，因为这些因素可以找出哪些患者最终可以停止服药，Lim教授说。

新加坡的试验是唯一针对感染标志物水平低的患者。

少数人将有资格学习

为了符合这里的研究资格，患者必须满足三个标准。

Lim教授说，他们的感染标记必须低于100，他们不能患肝硬化，他们必须接受口服药物治疗。 Arfan先生的感染标记水平只有两个，远低于他登记时的100的截止值。

通常，患者的水平达到数千。

虽然不知道有多少患者有这样的标记水平，但林教授说，只有少数患者才有资格获得这种标记。

截止日期基于其他研究。 Lim教授说，检测感染标记物的水平相对较新，相当昂贵而且不是常规使用，但患者可以免费接受NUH研究的一部分测试。

“我们不知道它有多常见，所以我会鼓励患者去测试，”他说。

这项研究也将在新加坡综合医院，Tan Tock Seng医院和樟宜综合医院开始，从国家医学研究委员会获得150万新元的资金。

它的目标是招募150名患者。其中50人将继续服用他们的药片，因此可以将停药的效果与他们进行比较。
资料来源：CNA / ja（hm）

neilhbver

也算是一种尝试，但是不能推广开，需要有经验的医生和大量的复查监控。