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替拉瑞韦(TVR)三联疗法治疗 102 例 HCV 基因 1 型患者的疗效和安全性:治疗 24 周后的中期分析。

Efficacy and safety of telaprevir (TVR) triple therapy in a 'real-life' cohort of 102 patients with HCV genotype 1: interim analysis after 24 weeks of treatment.

机构信息

Department of Gastroenterology, Hepatology, and Infectiology, University Hospital Tuebingen, Tuebingen, Germany.

出版信息

J Viral Hepat. 2014 May;21(5):333-40. doi: 10.1111/jvh.12145. Epub 2013 Aug 5.

Abstract

Since 2011, telaprevir (TVR)-based triple therapy is the new treatment standard for hepatitis C genotype 1 virus infection. The aim of our retrospective interim analysis encompassing the first 24 weeks on TVR-based triple therapy was to assess 'real-life' antiviral efficacy and side effects in a large single-centre cohort, both in comparison with the data obtained in large prospective clinical trials. In total, we treated 102 patients: 24 treatment-naïve patients, 58 patients pretreated with PEG-IFN/RBV (thereof: 28 with nonresponse, 25 with relapse, five unknown) and 20 patients who previously had received nonpegylated interferon. 74 of 102 patients were assigned with HCV genotype 1b; 34 of 102 patients were treated in the context of liver cirrhosis. 72 of 102 patients have reached treatment week 24 (mean treatment duration 31 weeks). In the ITT analysis, overall response rates were at: week 4: 66%; week 12: 85%; and week 24: 78%. So far, 24 patients discontinued treatment prematurely, of those, 10 patients were due to virological failure. Haematological side effects were frequent (40% anaemia), as were 'flu-like' symptoms (94%), rash (65%) and pruritus (79%). According to our interim ITT analysis encompassing up to 24 weeks of TVR-based triple therapy, our 'real-life' antiviral effects are comparable to the results of large multicentric clinical trials. However, TVR-based triple therapy exhibited a high frequency of side effects requiring multiple therapeutic interventions. Notably, in our 'real-life' cohort, no lethal case was observed so far.

摘要

自 2011 年以来,以特拉匹韦(TVR)为基础的三联疗法成为丙型肝炎病毒 1 型感染的新治疗标准。我们的回顾性中期分析涵盖了 TVR 三联疗法的前 24 周,旨在评估大型单中心队列中“真实生活”的抗病毒疗效和副作用,同时与大型前瞻性临床试验的数据进行比较。共有 102 名患者接受了治疗:24 名初治患者、58 名聚乙二醇干扰素/利巴韦林预处理患者(其中无应答者 28 名,复发者 25 名,5 名未知)和 20 名先前接受过非聚乙二醇干扰素治疗的患者。102 名患者中 74 名被诊断为丙型肝炎病毒 1b 基因型;102 名患者中有 34 名患有肝硬化。102 名患者中有 72 名完成了治疗 24 周(平均治疗持续时间为 31 周)。在 ITT 分析中,总体反应率为:第 4 周:66%;第 12 周:85%;第 24 周:78%。迄今为止,24 名患者过早停止治疗,其中 10 名患者因病毒学失败而停药。血液学副作用很常见(40%贫血),类似流感的症状(94%)、皮疹(65%)和瘙痒(79%)。根据我们的中期 ITT 分析,涵盖 TVR 三联疗法的前 24 周,我们的“真实生活”抗病毒效果与大型多中心临床试验的结果相当。然而,TVR 三联疗法表现出高频率的副作用,需要多次治疗干预。值得注意的是,在我们的“真实生活”队列中,迄今为止没有观察到致命病例。

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