Meta 分析：抗病毒治疗乙型肝炎 D。

Meta-analysis: antiviral treatment for hepatitis D.

机构信息

Department of Gastroenterology, University Hospital of Patras, Stamatopoulou 4, Patras, Greece.

出版信息

Aliment Pharmacol Ther. 2012 Mar;35(6):663-73. doi: 10.1111/j.1365-2036.2012.04993.x. Epub 2012 Jan 24.

DOI:10.1111/j.1365-2036.2012.04993.x

PMID:22273482

Abstract

BACKGROUND

There is no satisfactory treatment for patients with hepatitis D (HDV).

AIM

To evaluate treatment for HDV using meta-analysis.

METHODS

Medline, Scopus, Cochrane Library and ISI Web of Knowledge searches using the textwords 'Hepatitis D', 'therapy', "interferon", "peginterferon", "pegylated interferon", "lamivudine", "pegifn", "ifn" and "Hepatitis D", and abstracts from major Gastroenterology/Liver meetings.

ENDPOINTS

end of treatment biochemical (biochemical EOT) and virological response (virological EOT), end of follow-up virological response (EOFUP VR), histological improvement and intrahepatic HDAg clearance.

RESULTS

We included randomised clinical trials (RCTs) comparing Group A: interferon-A (IFNa) vs. no treatment (three RCTs, n ;= ;137 patients), Group B: low dose vs. high dose IFNa (two RCTs, n ;= ;60), Group C: IFNa ;+ ;lamivudine vs. IFNa (two RCTs, n ;= ;48) and Group D: pegylated IFNa (PEG-IFNa) vs. other medications (two RCTs, n ;= ;157). Group A. IFNa was better for biochemical EOT [OR, 0.11 (95% CI, 0.04-0.2)] and virological EOT [OR, 0.08 (95% CI, 0.03-0.2)], but not for EOFUP VR. Group B. High dose IFNa was better for biochemical EOT [OR, 0.24 (95% CI,0.08-0.73)] and virological EOT [OR, 0.27 (95% CI, 0.1-0.74)]. Group C. There was a trend favouring histological improvement [OR, 2.9 (95% CI, 0.6-13.4)]. Group D. PEG-IFNa was better for virological EOT [OR, 0.419 (95% CI, 0.18-0.974)], EOFUP VR [OR, 0.404 (95% CI, 0.189-0.866)] and improvement in necroinflammatory activity [OR, 0.308 (95% CI, 0.129-0.732)].

CONCLUSIONS

Long-term suppression of HDV RNA by IFNa is not maintained despite an end of treatment response; adding lamivudine is not beneficial. PEG-IFNa is superior to other medications with respect to EOT and EOFUP. New RCTs should test combinations of PEG-IFNa and newest antivirals.

摘要

背景

目前尚无满意的治疗乙型肝炎 D 型（HDV）的方法。

目的

通过荟萃分析评估治疗 HDV 的方法。

方法

使用 Medline、Scopus、Cochrane 图书馆和 ISI Web of Knowledge 搜索，使用的文本词为“乙型肝炎 D”、“治疗”、“干扰素”、“聚乙二醇干扰素”、“聚乙二醇干扰素”、“拉米夫定”、“pegifn”、“ifn”和“乙型肝炎 D”，以及主要胃肠病学/肝脏会议的摘要。

终点

治疗结束时的生化（生化 EOT）和病毒学应答（病毒学 EOT）、随访结束时的病毒学应答（EOFUP VR）、组织学改善和肝内 HDAg 清除。

结果

我们纳入了比较 A 组：干扰素-A（IFNa）与无治疗（3 项 RCT，n=137 例）、B 组：低剂量与高剂量 IFNa（2 项 RCT，n=60）、C 组：IFNa+拉米夫定与 IFNa（2 项 RCT，n=48）和 D 组：聚乙二醇干扰素（PEG-IFNa）与其他药物（2 项 RCT，n=157）的随机临床试验（RCT）。A 组：IFNa 对生化 EOT[OR，0.11（95%CI，0.04-0.2）]和病毒学 EOT[OR，0.08（95%CI，0.03-0.2）]更好，但对 EOFUP VR 无影响。B 组：高剂量 IFNa 对生化 EOT[OR，0.24（95%CI，0.08-0.73）]和病毒学 EOT[OR，0.27（95%CI，0.1-0.74）]更好。C 组：组织学改善有趋势[OR，2.9（95%CI，0.6-13.4）]。D 组：PEG-IFNa 对病毒学 EOT[OR，0.419（95%CI，0.18-0.974）]、EOFUP VR[OR，0.404（95%CI，0.189-0.866）]和坏死性炎症活动改善[OR，0.308（95%CI，0.129-0.732）]更好。