The Efficacy of Add-on Telbivudine Versus Switching to Pegylated Interferon Alfa-2a in Chronic Hepatitis B Patients With Poor Responses to Adefovir.
The Efficacy of Add-on Telbivudine Versus Switching to Pegylated Interferon Alfa-2a in Chronic Hepatitis B Patients With Poor Responses to Adefovir.
复制标题
添加替比夫定与改用聚乙二醇化干扰素 Alfa-2a 对阿德福韦酯反应不佳的慢性乙型肝炎患者的疗效
DOI：
10.5812/hepatmon.31278
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发表时间：
2016-01
影响因子：
0.6
通讯作者：
Hao C
中科院分区：
文献类型：
--
作者：
Wei X;Fan C;Zhou Y;Kang W;Wang J;Sun L;Wang L;Peng M;Lian J;Jia Z;Hao C
背景：对于阿德福韦酯（ADV）治疗效果差的慢性B型肝炎（CH B）患者，选择有限。目的：本研究的目的是评价在对初始ADV治疗反应较差的患者中，加用替比夫定（LdT）或改用聚乙二醇干扰素α-2a（PEG-IFN-α2a）作为替代补救治疗的效果。患者和方法：97例ADV单药治疗48周后HBV DNA > 2 log 10 copies/mL的CHB患者纳入本研究。其中59例患者每日接受LdT + ADV（LdT + ADV）联合治疗，而38例患者改为每周皮下注射PEG-IFN-α2a，持续48周。结果：两种抢救策略均安全，大多数患者耐受良好。与PEG-IFN-α2a单药治疗相比，LdT + ADV导致病毒载量下降更快，补救治疗后48周分别下降2.14（LdT + ADV）和0.98（PEG-IFN-α2a）log 10拷贝/mL（P < 0.00001）。在观察期结束时接受LdT + ADV联合治疗的患者中，病毒学应答和生化应答的发生率也升高（病毒学应答为88.1 vs. 68.4%，P = 0.017; 83.3 vs. 47.2%，P = 0.00045）。然而，在PEG-IFN-α2a治疗的患者中，B型肝炎表面抗原（HBsAg）的下降更明显。此外，转换为PEG-IFN-α2a治疗的患者的血清学应答累积率较高。结论：加用LdT和改用PEG-IFN-α2a治疗对ADV应答差的CHB患者均为满意和最佳的治疗方案。两种挽救策略均导致血清病毒载量和ALT水平显著降低，并且与我院的高血清学结局率相关。
Background: There are limited options for chronic hepatitis B (CHB) patients who have poor responses to adefovir (ADV). Objectives: The aim of this study is to evaluate the effects of adding on telbivudine (LdT) or switching to pegylated interferon alfa-2a (PEG-IFN-α2a) as alternative rescue therapies for patients with poor responses to the initial ADV treatments. Patients and Methods: Ninety-seven CHB patients with HBV DNA > 2 log10 copies/mL 48 weeks after ADV monotherapy were included in this study. Fifty-nine of these patients were treated with a combination of LdT plus ADV (LdT + ADV) daily, while thirty-eight patients were switched to PEG-IFN-α2a subcutaneous injections weekly for 48 weeks. Results: Both rescue strategies were proven to be safe and the majority of patients tolerated the therapies well. LdT + ADV led to more rapid reductions in viral loads than PEG-IFN-α2a monotherapy, with 2.14 (LdT + ADV) and 0.98 (PEG-IFN-α2a) log10 copies/mL decreases 48 weeks after rescue treatments, respectively (P < 0.00001). The rates corresponding to virological and biochemical responses were also elevated in patients who received the LdT + ADV combination therapy at the end of the observation period (88.1 vs. 68.4% for virological response, P = 0.017; 83.3 vs. 47.2%, P = 0.00045). However, the decline in the hepatitis B surface antigen (HBsAg) was more pronounced in PEG-IFN-α2a treated patients. Moreover, the cumulative rates of serological responses were higher in patients who switched to the PEG-IFN-α2a therapy. Conclusions: Both add-on LdT and switching to PEG-IFN-α2a were satisfactory and optimal treatments for CHB patients with poor responses to ADV. Both rescue strategies resulted in significant reductions in serum viral load and ALT levels, and were associated with high rate of serological outcomes in our hospital.