乙型肝炎e抗原阴性慢性乙型肝炎的有限核苷（酸）类似物治

StephenW

乙型肝炎e抗原阴性慢性乙型肝炎的有限核苷（酸）类似物治疗：从“选择”到“积极推荐”
廖云凡 1 2 , 钱荣南 1 2 3
隶属关系
隶属关系

    1
    台湾桃园长庚大学医学院.
    2
    台湾桃园长庚纪念医院肝脏研究室。
    3
    台湾桃园长庚纪念医院林口分院肠胃肝病科。

    PMID：35262284 DOI：10.1002/kjm2.12518

抽象的

包括恩替卡韦、富马酸替诺福韦酯和替诺福韦艾拉酚胺在内的核苷（酸）类似物 (Nuc) 可以显着抑制乙型肝炎病毒 (HBV) DNA，但对共价闭合环状 DNA 没有直接作用，而共价闭合环状 DNA 是一种非常稳定的 HBV 生产模板。因此，需要数十年的长期 Nuc 治疗来维持 HBV 抑制并实现乙型肝炎 e 抗原 (HBeAg) 阴性患者的乙型肝炎表面抗原 (HBsAg) 丢失。然而，存在财务负担、依从性和无限期长期 Nuc 治疗的意愿等问题。失访且因此未进行监测的患者可能有严重复发的风险，可能恶化为肝功能失代偿甚至肝功能衰竭。 HBeAg 阴性患者停止 Nuc 治疗最初是在 2000 年代初考虑的。早期在亚洲患者中发现，2-3 年的有限 Nuc 治疗是可行和安全的，因此自 2008 年以来，亚太地区肝停规则研究协会成立。随后的研究证实了有限 Nuc 治疗策略的可行性和安全性，自 2016 年以来，它终于被美国和欧洲肝脏协会接受为“一种选择”。自 2018 年以来最近的大型研究进一步证实了停止 Nuc 治疗后 HBsAg 丢失率（约 5 年 39%）大大增加的关键发现。以高 HBsAg 消失率作为主要理由，HBeAg 阴性患者从无限期长期治疗到有限 Nuc 治疗的范式转变已从“选择”转变为旨在实现 HBsAg 消失的“积极推荐”。需要更多的研究来微调策略，包括研究巩固治疗的最佳持续时间、停止时间和开始再治疗。

关键词：HBsAg 丢失；宿主主导的耀斑；再处理决定；停止规则；以病毒为主的耀斑。

© 2022 作者。 John Wiley & Sons Australia, Ltd 代表高雄医科大学出版的高雄医学杂志。

StephenW

Finite nucleos(t)ide analogue therapy in hepatitis B e antigen-negative chronic hepatitis B: From an "option" to an "active recommendation"
Yun-Fan Liaw  1   2 , Rong-Nan Chien  1   2   3
Affiliations
Affiliations

    1
    College of Medicine, Chang Gung University, Taoyuan, Taiwan.
    2
    Liver Research Unit, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
    3
    Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.

    PMID: 35262284 DOI: 10.1002/kjm2.12518

Abstract

Nucleos(t)ide analogue (Nuc) including entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide may suppress hepatitis B virus (HBV) DNA profoundly but have no direct action on covalently closed circular DNA, which is a very stable template for HBV production. Therefore, decades of long-term Nuc therapy are required to maintain HBV suppression and to achieve hepatitis B surface antigen (HBsAg) loss in hepatitis B e antigen (HBeAg)-negative patients. However, there are concerns including financial burden, adherence, and willingness for indefinite long-term Nuc therapy. Patients lost to follow-up and hence not monitored may risk severe relapse that may deteriorate to hepatic decompensation or even hepatic failure. Cessation of Nuc therapy in HBeAg-negative patients was initially considered in early 2000s. Earlier findings in Asian patients that finite Nuc therapy over 2-3 years is feasible and safe have founded Asian-Pacific Association for the Study of Liver stopping rule since 2008. Subsequent studies have confirmed the feasibility and safety of the strategy of finite Nuc therapy, which has finally been accepted as "an option" by American and European liver associations since 2016. More recent large studies since 2018 have further confirmed the pivotal finding of greatly increased HBsAg loss rate (~5-year 39%) after stopping Nuc therapy. With the high HBsAg loss rate as the main justification, the paradigm shift from indefinite long-term therapy to finite Nuc therapy in HBeAg-negative patients has been changing from an "option" to an "active recommendation" aiming to achieve HBsAg loss. More studies are needed to fine-tuning the strategy, including research for the optimal duration of consolidation therapy, timing to stop, and to start retreatment.

Keywords: HBsAg loss; host-dominating flare; retreatment decision; stopping rule; virus-dominating flare.

© 2022 The Authors. The Kaohsiung Journal of Medical Sciences published by John Wiley & Sons Australia, Ltd on behalf of Kaohsiung Medical University.

StephenW

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/kjm2.12518

lizyong22

这个比例还是可观的，也有多个报道停药后S持续走低，但有部分人停药后爆肝复发，所以让更多的人失去了停药的机会

lancas

之前不是说亚洲人停药清除几率非常的地低么~~这种治疗方式可能不适合亚洲人种