The Glucagon-Like Peptide-1 Receptor Agonist, Semaglutide, for the Treatment of Nonalcoholic Steatohepatitis.
The Glucagon-Like Peptide-1 Receptor Agonist, Semaglutide, for the Treatment of Nonalcoholic Steatohepatitis.
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DOI：
10.1002/hep.31886
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发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Dichtel LE
中科院分区：
文献类型：
--
作者：
Dichtel LE
讨论 目前尚无临床指南支持 SOF/VEL/VOX 抢救治疗失败的患者进行复治时的决策。基因型 3 HCV 与我们 3/5 的患者一致，更有可能难以治疗。虽然 Bourlière 等人 (3) 报道，接受 SOF/VEL/VOX 治疗的基因型 3 患者中有 95% 实现了 SVR，但该研究仅纳入了肝硬化患者中的少数基因型 3 感染，因此很难概括该亚组的结果。有趣的是，虽然治疗中可能会出现 RAS，但我们在 SOF/VEL/VOX 治疗后没有检测到任何 RAS 变化。唯一检测到的 RAS 是 NS5A 氨基酸位置 93 的替换，已知该替换可赋予对维帕他韦等 NS5A 抑制剂的高水平耐药性。然而，这种替代仍然容易受到 PIB 的影响，(5) 促使我们选择再治疗。与 Dietz 等人相反，(4) 我们的患者接受了 16 周的标准治疗（相对于 12-24 周），SVR12 为 100%。此外，我们仅纳入代偿性肝病患者，因为失代偿性肝硬化禁用蛋白酶抑制剂。我们的观察证实，当 SOF/VEL/VOX 失败时，SOF/GLE/PIB/RBV 是一种有前途的替代救援治疗方法，需要进一步研究来验证这种治疗选择。文章信息：
DiscussionThere are currently no clinical guidelines to support decision-making when retreating patients failing SOF/VEL/VOX rescue therapy. Genotype 3 HCV, consistent with 3/5 of our patients, is more likely to be difficult to treat. While Bourlière et al.(3) reported that 95% of genotype 3 patients treated with SOF/VEL/VOX achieved an SVR, the study only included a few genotype 3 infections in patients with cirrhosis, making it difficult to generalize results in this subgroup. Interestingly, although treatment-emergent RASs can occur, we did not detect any RAS changes after SOF/VEL/VOX therapy. The only detected RAS was a substitution at NS5A amino acid position 93, which is known to confer a high level of resistance to NS5A inhibitors like velpatasvir. However, this substitution is still susceptible to PIB,(5) motivating our choice of retreatment. In contrast to Dietz et al.,(4) our patients received 16 weeks of treatment as standard (versus 12-24 weeks), resulting in an SVR12 of 100%. Furthermore, we only included patients with compensated liver disease as protease inhibitors are contraindicated in decompensated cirrhosis. Our observations confirm that SOF/GLE/PIB/RBV represents a promising alternative rescue treatment when SOF/VEL/VOX fails, and further studies are necessary to validate this therapeutic option. aRtICle INFoRMatIoN:
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DOI：
10.1056/nejmoa1603827
发表时间：
2016-07-28
期刊：
The New England journal of medicine
影响因子：
--
作者：
Marso SP;Daniels GH;Brown-Frandsen K;Kristensen P;Mann JF;Nauck MA;Nissen SE;Pocock S;Poulter NR;Ravn LS;Steinberg WM;Stockner M;Zinman B;Bergenstal RM;Buse JB;LEADER Steering Committee;LEADER Trial Investigators
通讯作者：
LEADER Trial Investigators
影响因子：
158.5
作者：
Newsome, Philip N.;Buchholtz, Kristine;Harrison, Stephen A.
通讯作者：
Harrison, Stephen A.
影响因子：
168.9
作者：
Armstrong, Matthew James;Gaunt, Piers;Newsome, Philip N.
通讯作者：
Newsome, Philip N.
影响因子：
16.2
作者：
通讯作者：
--
影响因子：
29.4
作者：
Vilar-Gomez, Eduardo;Martinez-Perez, Yadina;Romero-Gomez, Manuel
通讯作者：
Romero-Gomez, Manuel