chronic hepatitis B – anti-viral or immunomodulatory therapy?

StephenW

<http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2010.04555.x/abstract;jsessionid=D1AF2D7CC601024CF3249760D42A8EBD.d03t01>

Review article: chronic hepatitis B – anti-viral or immunomodulatory therapy?

V. Rijckborst, M. J. Sonneveld, H. L. A. JanssenArticle first published online:
29 DEC 2010

DOI: 10.1111/j.1365-2036.2010.04555.x
© 2010 Blackwell Publishing Ltd
Issue

Alimentary Pharmacology & Therapeutics
Early View (Articles online in advance of print)

Summary

Background  First-line treatment options for chronic hepatitis B (CHB) consist
of nucleos(t)ide analogues with a high barrier to resistance (entecavir and
tenofovir) or the immunomodulatory agent peginterferon (PEG-IFN). The optimal
choice for individual patients remains controversial.

Aim  To review treatment options for CHB, with a focus on deciding between
prolonged nucleos(t)ide analogue therapy or a finite course of PEG-IFN.

Methods  A comprehensive literature search was undertaken.

Results  Long-lasting, treatment-maintained suppression of hepatitis B virus
(HBV) DNA without resistance is achievable in most patients by entecavir or
tenofovir. A sustained off-treatment response is, however, unlikely and
long-term therapy must be anticipated. PEG-IFN offers a higher rate of sustained
response in a subgroup of patients, but is frequently complicated by side
effects. Pre-treatment predictors of response, including HBV genotype, alanine
aminotransferase and HBV DNA levels, aid in selecting patients for PEG-IFN
therapy. Furthermore, on-treatment markers such as quantitative hepatitis B
surface antigen may be applied to identify nonresponders early during the
PEG-IFN treatment course, thereby preventing unnecessary treatment.

Conclusions  Both nucleos(t)ide analogues and PEG-IFN can be prescribed as
first-line treatment options for CHB. However, PEG-IFN should only be considered
for patients with a high chance of response based on pre-treatment and
on-treatment factors.

评论文章：慢性乙型肝炎 - 抗病毒或免疫调节治疗？

五，Rijckborst，兆焦耳Sonneveld和HLA JanssenArticle首次在网上公布：
2010年12月29日

分类号：10.1111/j.1365-2036.2010.04555.x
© 2010布莱克韦尔出版有限公司
发行

消化系统药理学与治疗学
厄尔利维尤（第预先在网上打印）

综述

背景一线治疗慢性乙型肝炎（CHB）组成的治疗方案
对核苷（酸）类似物的IDE具有高障碍性（恩替卡韦和
泰诺福韦）或免疫调节剂长效干扰素（聚乙二醇干扰素）。最佳
个别病人的选择仍存在争议。

目的在于审查为慢性乙型肝炎的治疗方案，并决定对重点之间
长时间的核苷（酸）类似物治疗的IDE或聚乙二醇干扰素有限的课程。

方法进行了全面的文献检索。

结果长效，治疗维持的抑制乙肝病毒
（HBV）的DNA是在没有抵抗大多数患者的恩替卡韦或实现
泰诺福韦。持续的非治疗反应不过，不太可能，
长期治疗，必须预期。聚乙二醇干扰素提供了一个较高的速度持续
反应的患者群，但往往是复杂的一面
影响。前处理预测的反应，包括乙肝病毒基因型，丙氨酸
转氨酶和乙肝病毒DNA水平，帮助选择聚乙二醇干扰素的病人
治疗。此外，诸如乙肝定量处理标记
表面抗原可用于识别在早期无应答
聚乙二醇干扰素治疗过程中，从而避免不必要的治疗。

结论两种核苷（酸）类似物的IDE和PEG -干扰素可规定为
对慢性乙型肝炎的一线治疗方案。然而，聚乙二醇化干扰素只应考虑
对前处理，并根据与一患者的反应的机会很高
上治疗因素。