A comparison of lamivudine vs entecavir for prophylaxis of hepatitis B virus reactivation in allogeneic hematopoietic stem cell transplantation recipients: a single-institutional experience
A comparison of lamivudine vs entecavir for prophylaxis of hepatitis B virus reactivation in allogeneic hematopoietic stem cell transplantation recipients: a single-institutional experience
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拉米夫定与恩替卡韦预防异基因造血干细胞移植受者乙型肝炎病毒再激活的比较：单机构经验
DOI：
10.1038/bmt.2015.328
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发表时间：
2016-04-01
影响因子：
4.8
通讯作者：
Liu, Q.
中科院分区：
文献类型：
--
作者：
Shang, J.;Wang, H.;Liu, Q.
本研究的目的是比较拉米夫定与恩替卡韦在预防接受异基因造血干细胞移植（allo-HSCT）的HBV表面抗原（HBsAg）阳性患者中的B型肝炎病毒（HBV）再激活方面的疗效。共有216例连续患者入组并进行回顾性分析。在这些患者中，119例接受拉米夫定治疗，97例接受恩替卡韦治疗。基线HBV-DNA水平> 105拷贝/mL的患者，恩替卡韦组至病毒学完全缓解的中位治疗时间为2.0个月，明显短于拉米夫定组。移植后中位随访24个月，拉米夫定组移植后6、12和24个月HBV再激活的累积发生率分别为3.0%、7.0%和24.0%，恩替卡韦组分别为0%、0%和2.0%。此外，恩替卡韦治疗与较低的HBV再激活引起的重型肝炎累积发生率相关。在拉米夫定组的25名患者中检测到导致耐药性的突变，而在恩替卡韦组仅检测到1名患者。我们的数据表明，与拉米夫定相比，恩替卡韦具有更强的抗病毒疗效，可能是一个更好的选择，用于预防HBV再激活的HBsAg阳性allo-HSCT受者。
The aim of this study was to compare the efficacy of lamivudine vs entecavir in the prevention of hepatitis B virus (HBV) reactivation in HBV surface Ag (HBsAg)-positive patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). A total of 216 consecutive patients were enrolled and retrospectively reviewed. Of these patients, 119 received lamivudine and 97 received entecavir. The median treatment duration to complete virological response in patients with baseline HBV-DNA levels> 10 5 copies/mL was 2.0 months in the entecavir group, significantly shorter than that of the lamivudine group. After a median follow-up of 24 months post transplantation, the cumulative incidence rates of HBV reactivation at 6, 12 and 24 months following transplantation were 3.0%, 7.0% and 24.0% in the lamivudine group, and 0%, 0% and 2.0% in the entecavir group, respectively. In addition, entecavir treatment was associated with lower cumulative incidence rates of severe hepatitis caused by HBV reactivation. Mutations leading to drug resistance were detected in 25 patients in the lamivudine group and in only one patient in the entecavir group. Our data indicate that compared with lamivudine, entecavir has more potent antiviral efficacy and may be a better choice for prophylaxis of HBV reactivation in HBsAg-positive allo-HSCT recipients.