长效干扰素比拉米夫丁更加有效(2005.7.10)

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Peginterferon more effective than lamivudine for chronic hepatitis B


  
  NEW YORK (Reuters Health) - In patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B, treatment with peginterferon alfa-2a or peginterferon alfa-2a plus lamivudine is superior to lamivudine monotherapy in reducing viral load and inducing seroconversion of HBeAg and hepatitis B surface antigen (HBsAg), investigators report.

The findings, which appear in The New England Journal of Medicine for June 30, are based on a multicenter study of patients who were randomized to receive peginterferon alfa-2a (180 microgram/week) plus placebo (n = 271), peginterferon alfa-2a plus lamivudine (100 mg daily, n = 271) or lamivudine plus placebo (n = 272) for 48 weeks, followed by 24 weeks of treatment-free follow-up.

Lead author Dr. George K. K. Lau, from the University of Hong Kong, and his associates report that, after 48 weeks, 52% treated with peginterferon alfa-2a monotherapy achieved hepatitis B DNA suppression to < 100,000 copies/mL, as did 86% of those receiving dual therapy and 62% of those taking lamivudine.

After 72 weeks, corresponding rates of viral load suppression were 32, 34%, and 22%. Both peginterferon alfa-2a groups were significantly more effective at reducing levels of virus than lamivudine (p = 0.01 and 0.003, respectively).

At 72 weeks, 41%, 39% and 28% of patients, respectively, had normalized levels of alanine aminotransferase. Corresponding rates of HBeAg seroconversion were 32%, 27% and 19%. HBsAg seroconversion occurred in 16 of those on peginterferon alfa-2a and in none of those on lamivudine monotherapy, the authors note.

Serious adverse events occurred in 4% of the peginterferon alfa-2a group, 2% of the lamivudine group and 6% of the dual therapy group. Two patients receiving lamivudine monotherapy had hepatic decompensation, leading to liver transplantation in one and death in the other.

"The ability to achieve HBeAg and HBsAg seroconversion after a defined period of peginterferon alfa-2a therapy supports the use of peginterferon alfa-2a as a first-line therapy for patients with HBeAg-positive chronic hepatitis B," Dr. Lau's team concludes.

In a related editorial, Dr. Anna Suk-Fong Lok, from the University of Michigan Medical Center in Ann Arbor, points out that "treatment is recommended for patients with high HBV DNA levels, but it is unclear whether patients with low hepatitis B DNA levels will derive the same benefits."

"Given the propensity for hepatitis B virus to persist," she adds, "patients should be closely monitored when treatment is stopped, to avoid fatal flares."

N Engl J Med 2005;352:2682-2695,2743-2746.

Cessation of adefovir treatment in hepatitis B leads to rebound - (06/30/05)
http://www.natap.org/2005/HBV/063005_03.htm

The Maze of Treatments for Hepatitis B - (06/30/05)
http://www.natap.org/2005/HBV/063005_02.htm

Peginterferon Alfa-2a, Lamivudine, and the Combination for HBeAg-Positive Chronic Hepatitis B - (06/30/05)
http://www.natap.org/2005/HCV/062305_01.htm  

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搞点中文出来嘛[em04]

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为大家做点贡献，翻译如下：

对慢性乙肝长效干扰素比拉米夫丁更加有效(2005.7.10) [br]

纽约（路透社健康讯）使用长效干扰素α-2a或长效干扰素α-2a与拉米夫定联合用药比单纯用拉米夫定治疗HBeAg阳性的慢性乙肝病人，能明显减少病毒复制且增加HBeAg和HBsAg的转阴率，调查员报导。

这篇于6月30日发表在The New England Journal of Medicine（《英格兰医学杂志》，国际上非常权威的医学杂志）上的文章，是一项随机、临床多中心研究。研究中患者随机分别接受长效干扰素α-2a（180μg/周）加安慰剂(n = 271)，长效干扰素α-2a加拉米夫定（100 mg/日，n = 271）和拉米夫定加安慰剂(n = 272)的治疗，治疗时间共48周，然后停止治疗24周。

这位香港大学的项目负责人George K. K. Lau博士和他的助手报导，经过48周治疗后，单纯长效干扰素α-2a治疗组有52%的病人HBV　DNA＜100,000 个/mL，而联合用药组有86%的病人，单纯拉米夫定组有62%。

72周后，上述病毒复制的抑制率分别为32%、34%和22%，使用长效干扰素的两个组抑制病毒复制的效果均明显优于单纯拉米夫定组（p 分别为 0.01 和0.003）

在72周后，三组分别有41%、39%和28%的病人转氨酶降至正常水平，HBeAg的转阴率分别为32%、27%和19%。HBsAg转阴的在使用长效干扰素的有16例病人，但在单纯拉米夫定组中无1例转阴。

在长效干扰素组有4%严重不良反应，拉米夫定组仅2%，联合用药组有6%。单纯拉米夫定组出现2例肝衰竭，其中1例进行了肝移植手术，另一例死亡。

Lau博士研究组总结道：在进行一定时间的长效干扰素治疗后，其表现的HBeAg和 HBsAg转阴效果，表明长效干扰素α-2a可作为HBV　HBeAg阳性患者的一线治疗药物。

在一篇相关文章中，密歇根医科大学的Anna Suk-Fong Lok博士指出：对高HBV　DNA水平的患者，推荐使用长效干扰素，但对低HBV　DNA水平的患者是否有同样的疗效尚不清楚。

她还补充道：在停止治疗后，病人必须严密监测各项指标，以避免致命的不良反应。

英格兰医学杂志，2005; 352:2682-2695,2743-2746.

[br]Cessation of adefovir treatment in hepatitis B leads to rebound - adefovir 治疗乙肝停药后导致的反弹(06/30/05)[br]http://www.natap.org/2005/HBV/063005_03.htm[br][br]The Maze of Treatments for Hepatitis B –乙肝治疗之迷 (06/30/05)[br]http://www.natap.org/2005/HBV/063005_02.htm[br][br]Peginterferon Alfa-2a, Lamivudine, and the Combination for HBeAg-Positive Chronic Hepatitis B –长效干扰素α-2a、拉米夫定及其联合治疗乙肝HBeAg阳性患者 (06/30/05)[br]http://www.natap.org/2005/HCV/062305_01.htm

[此贴子已经被作者于2005-7-13 12:52:20编辑过]