Sustained response after a 2-year course of lamivudine treatment of hepatitis B e antigen-negative chronic hepatitis B
Sustained response after a 2-year course of lamivudine treatment of hepatitis B e antigen-negative chronic hepatitis B
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DOI：
10.1111/j.1365-2893.2004.00556.x
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发表时间：
2004-09-01
影响因子：
2.5
通讯作者：
Lok, ASF
中科院分区：
文献类型：
--
作者：
Fung, SK;Wong, F;Lok, ASF
拉米夫定已被证明对治疗B型肝炎e抗原阴性的慢性B型肝炎（e-CH B）有效。然而，1年后停药与高复发率相关，而长期治疗与耐药性风险增加相关。我们报告我们的治疗经验，50例华裔加拿大人与e-CHB。所有患者均接受拉米夫定治疗2年。在治疗的第二年，PCR检测不到B型肝炎病毒（HBV）DNA且转氨酶正常的患者在第24个月停止治疗。所有患者均为HBV基因型B或C。第6、12和24个月的生化反应分别为74%、71%和66%。在第6、12和24个月，分别有100%、92%和86%的患者和94%、88%和74%的患者通过杂交捕获和PCR检测HBV DNA未检出。1年和2年后基因型抗性（GR）累积率分别为15%和25%。4例（44%）GR患者发生肝炎发作。停药后6、12和18个月的临床和病毒学复发概率分别为12%和30%、18%和50%以及30%和50%。重新使用拉米夫定导致迅速的病毒学和生化反应。我们的研究表明，拉米夫定2年疗程后，在一个亚组的慢性乙型肝炎患者可以实现持续的反应。
Lamivudine has demonstrated efficacy for the treatment of hepatitis B e antigen-negative chronic hepatitis B (e-CHB). However, treatment withdrawal after 1 year has been associated with a high rate of relapse while long-term treatment is associated with increasing risks of drug resistance. We report our treatment experience of 50 Chinese-Canadian patients with e-CHB. All patients received lamivudine for 2 years. Treatment was withdrawn at month 24 in patients who had undetectable hepatitis B virus (HBV) DNA by PCR and normal aminotransferases during the second year of therapy. All patients had HBV genotype B or C. Biochemical response at months 6, 12 and 24 was 74%, 71% and 66%, respectively. HBV DNA was undetectable at months 6, 12 and 24 by hybrid capture and PCR assays in 100%, 92% and 86%; and 94%, 88% and 74% patients, respectively. The cumulative rates of genotypic resistance (GR) after 1 and 2 years were 15% and 25%, respectively. Four (44%) patients with GR experienced a hepatitis flare. The probability of clinical and virological relapse 6, 12, and 18 months after treatment withdrawal were 12% and 30%, 18% and 50%, and 30% and 50%, respectively. Reinstitution of lamivudine resulted in prompt virological and biochemical responses. Our study demonstrates that a sustained response can be achieved after a 2-year course of lamivudine in a subset of patients with e-CHB.