HBeAg阳性慢性乙型肝炎的序贯联合疗法：搜寻仍在继续

StephenW

Sequential combination therapies for HBeAg-positive chronic hepatitis B: the search continues

    Ankur Jindal & Manoj Kumar

Hepatology International volume 15, pages1–3(2021)Cite this article

    171 Accesses

    Metrics details

Total eradication of the hepatitis B virus (HBV) is still elusive, as even if HBsAg is lost, covalently closed circular DNA (cccDNA) often persists in the hepatocytes. The currently available drugs for treatment of chronic hepatitis B (CHB) are not able to give sustained off-treatment HBsAg loss (functional cure) in most of the patients, which is the ultimate goal of therapy of CHB and is closest to eradication. In the absence of functional cure, Hepatitis B e antigen (HBeAg) seroconversion and undetectable HBV DNA are taken as end-points of antiviral therapy in HBeAg-positive CHB.

At present, monotherapy with potent nucleot(s)ide analogues (NAs) (directly inhibit HBV DNA polymerase) or pegylated interferon alpha (Peg-IFN) (immune modulator) is recommended as the first-line therapy for HBeAg-positive CHB. Long-term potent NA treatment has excellent viral suppression (more than 95% at 5 years) [1], but relapse is common after stopping NAs. Therefore, prolongation of potent NAs therapy over long period maintains the initially high virological remission rates. The rationale for Peg-IFN use is to induce immunological control with a finite duration of therapy [2]. However, the response to Peg-IFN treatment is highly variable and it has more side effects as compared to NAs. Among HBeAg-positive CHB patients, Peg-IFN therapy leads to higher HBeAg seroconversion and HBsAg seroclearance rates as compared to NAs, but the sustained virologic response rates at 6 months following 12 months of Peg-IFNa therapy are ~ 20–30% [3]. Baseline predictors for good response to Peg-IFN treatment include lower HBV DNA levels (< 7 log10 IU/ml) and higher ALT levels (2–3 times ULN) [1].

StephenW

HBeAg阳性慢性乙型肝炎的序贯联合疗法：搜寻仍在继续

    安库·金达尔（Ankur Jindal）和玛诺·玛玛（Manoj Kumar）

国际肝病杂志第15卷，第1-3（2021）页，引用本文

    171次访问

    指标详细信息

乙型肝炎病毒（HBV）的彻底根除仍然遥遥无期，因为即使HBsAg丢失，共价闭合的环状DNA（cccDNA）也经常存在于肝细胞中。目前，用于治疗慢性乙型肝炎（CHB）的药物在大多数患者中均无法提供持续的治疗后HBsAg丢失（功能性治愈），这是CHB治疗的最终目标，并且最接近于根除。在没有功能性治愈的情况下，乙型肝炎e抗原（HBeAg）血清转化和无法检测到的HBV DNA被视为HBeAg阳性CHB中抗病毒治疗的终点。

目前，推荐使用强效核苷酸类似物（NAs）（直接抑制HBV DNA聚合酶）或聚乙二醇化干扰素α（Peg-IFN）（免疫调节剂）的单一疗法作为HBeAg阳性CHB的一线疗法。长期有效的NA治疗具有出色的病毒抑制作用（5年时超过95％）[1]，但停止NAs后复发很常见。因此，长期延长有效的NAs治疗可维持最初较高的病毒学缓解率。使用Peg-IFN的基本原理是在有限的治疗期间内诱导免疫控制[2]。然而，与NAs相比，对Peg-IFN治疗的反应是高度可变的，并且具有更多的副作用。在HBeAg阳性CHB患者中，与NAs相比，Peg-IFN治疗可导致更高的HBeAg血清转化率和HBsAg血清清除率，但在12个月Peg-IFNa治疗后6个月持续的病毒学应答率约为20％至30％[3]。 ]。对Peg-IFN治疗有良好反应的基线预测指标包括较低的HBV DNA水平（<7 log10 IU / ml）和较高的ALT水平（2-3倍ULN）[1]。

StephenW

https://link.springer.com/articl ... c_springer_20210217