慢性乙型肝炎抗病毒治疗的挑战与策略——如何实现临床治愈最大化

王伟静; 谢青

doi:10.3969/j.issn.1001-5256.2017.08.002

慢性乙型肝炎抗病毒治疗的挑战与策略——如何实现临床治愈最大化

DOI: 10.3969/j.issn.1001-5256.2017.08.002

王伟静,
谢青

上海交通大学医学院附属瑞金医院北院感染科

基金项目:

上海市公共卫生三年行动计划(15GWZK0102)；上海市级医院临床技能与临床创新三年行动计划(16CR1002A)；

详细信息

中图分类号: R512.62
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出版历程
- 收稿日期: 2017-06-29
- 出版日期: 2017-08-20

Challenges and strategies of antiviral therapy for chronic hepatitis B-how to achieve the maximization of clinical cure?

Department of Infectious Diseases, Northern Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

Research funding:

摘要

摘要: HBV感染是全球重要的公共卫生问题,抗病毒治疗是阻止慢性乙型肝炎（CHB）患者疾病进展和改善预后的关键治疗方案。全球多个指南均推荐强效低耐药核苷和核苷酸类药物（NAs）及长效干扰素（PEG-IFN）为一线抗病毒治疗方案。但长期服用NAs存在疗程长、较低的HBeAg血清学转换率、极低的HBsAg清除或血清学转换率、安全性及耐药性等一系列弊端。因此,提高NAs经治患者的HBeAg和HBsAg血清学转换率,实现临床治愈是目前CHB治疗中需要关注的一个重要问题。近年来,多项全球性随机临床试验如OSST、Switch及ARES等均提示NAs联合或者序贯PEG-IFN能够提高CHB患者HBeAg及HBsAg的血清学转换率,实现临床治愈,为NAs治疗CHB患者提供了新方向。
- 肝炎,乙型,慢性 /
- 抗病毒药 /
- 核酸类,核苷酸类和核苷类 /
- 干扰素类 /
- 述评
Abstract: Hepatitis B virus infection is still a major public health issue in the world, and antiviral therapy is the key therapeutic regimen to delay disease progression and improve outcome in patients with chronic hepatitis B ( CHB) . Various international guidelines recommend nucleos ( t) ide analogues ( NAs) and long-acting interferon as the first-line antiviral therapy. However, long-term administration of NAs has the disadvantages of long course of treatment, low HBeAg seroconversion rate, extremely low HBsAg clearance or seroconversion rate, low safety, and drug resistance. Therefore, it is an important issue to increase the seroconversion rates of HBeAg and HBsAg in treatment-experienced patients and realize clinical cure in the treatment of CHB. In recent years, many global randomized clinical trials including OSST, Switch, and ARES have shown that a combination of NAs and PEG-IFN or sequential therapy with NAs and PEG-IFN can increase the seroconversion rates of HBeAg and HBsAg in CHB patients and realize clinical cure, which provides a new direction for NAs in the treatment of CHB patients.
- hepatitis B, chronic /
- antiviral agents /
- nucleic acids, nucleotides, and nucleosides /
- interferons /
- editorial

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参考文献(13)

[1]CHAN HL, THOMPSON A, MARTINOT-PEIGNOUX M, et al.Hepatitis B surface antigen quantification:why and how to use it in2011---a core group report[J].J Hepatol, 2011, 55 (5) :1121-1131.

[2]LAI CL, GANE E, LIAW YF, et al.Telbivudine versus lamivudine in patients with chronic hepatitis B[J].N Engl J Med, 2007, 357 (25) :2576-2588.

[3]CHANG TT, GISH RG, de MAN R, et al.A comparison of entecavir and lamivudine for HBeA g-positive chronic hepatitis B[J].N Engl J Med, 2006, 354 (10) :1001-1010.

[4]MARCELLIN P, HEATHCOTE EJ, BUTI M, et al.Tenofovir disoproxil fumarate versus adefovir dipivoxil for chronic hepatitis B[J].N Engl J Med, 2008, 359 (23) :2442-2455.

[5]KWON YJ, LEE HS, PARK MJ, et al.Comparison of the efficacy of tenofovir and entecavir for the treatment of nucleos (t) ide-na6ve patients with chronic hepatitis B[J].Niger J Clin Pract, 2015, 18 (6) :796-801.

[6]CHEVALIEZ S, HZODE C, BAHRAMI S, et al.Long-term hepatitis B surface antigen (HBsA g) kinetics during nucleoside/nucleotide analogue therapy:finite treatment duration unlikely[J].J Hepatol, 2013, 58 (4) :676-683.

[7]LAU GK, PIRATVISUTH T, LUO KX, et al.Peginterferon alfa-2a, lamivudine, and the combination for HBeA g-positive chronic hepatitis B[J].N Engl J Med, 2005, 352 (26) :2682-2695.

[8] LI MH, HU LP, ZHANG L, et al.Efficacy of pegylated-interferon alpha-2a treatment in patients with HBeA g-positive chronic hepatitis B and partial viral response to nucleoside analogue therapy[J].Chin J Hepatol, 2015, 23 (11) :826-831. (in Chinese) 李明慧, 胡蕾苹, 张璐, 等.HBeA g阳性慢性乙型肝炎用核苷 (酸) 类似物治疗部分病毒学应答患者转换聚乙二醇干扰素α-2a治疗的研究[J].中华肝脏病杂志, 2015, 23 (11) :826-831.

[9]LIAW YF, JIA JD, CHAN HL, et al.Shorter durations and lower doses of peginterferon alfa-2a are associated with inferior hepatitis B e antigen seroconversion rates in hepatitis B virus genotypes B or C[J].Hepatology, 2011, 54 (5) :1591-1599.

[10]HU P, DOU X, JIANG J, et al.Increased and sustained HBsA g loss in HBeA g positive CHB patients switched from NUC to PegIFN alfa-2a:a randomised open label trial (NEW SWITCH study) [J].Hepatology, 2016, 63:36a-37a.

[11]NING Q, HAN M, SUN Y, et al.Switching from entecavir to PEG-IFN alfa-2a in patients with HBeA g-positive chronic hepatitis B:a randomised open-label trial (OSST trial) [J].J Hepatol, 2014, 61 (4) :777-784.

[12]BROUWER WP, XIE Q, SONNEVELD MJ, et al.Adding pegylated interferon to entecavir for hepatitis B e antigen-positive chronic hepatitis B:a multicenter randomized trial (ARES study) [J].Hepatology, 2015, 61 (5) :1512-1522.

[13]LI GJ, YU YQ, CHEN SL, et al.Sequential combination therapy with pegylated interferon leads to loss of hepatitis B surface antigen and hepatitis B e antigen (HBeA g) seroconversion in HBeA g-positive chronic hepatitis B patients receiving long-term entecavir treatment[J].Antimicrob Agents Chemother, 2015, 59 (7) :4121-4128.

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