IFI Institute at the Asklepios Klinik St Georg Hamburg, University of Hamburg, Hamburg, Germany.
Liver Int. 2015 Jan;35 Suppl 1:114-20. doi: 10.1111/liv.12720.
Currently available antiviral treatment for chronic hepatitis B can be divided into two classes of therapeutic agents: pegylated interferon alpha (PEG-IFN) and nucleos(t)ide analogues (NAs). The major advantages of NAs are good tolerance and potent antiviral activity associated with high rates of on-treatment response to therapy. The advantages of PEG-IFN include a finite course of treatment, the absence of drug resistance, and an opportunity to obtain a durable post-treatment response to therapy. The use of these two antiviral agents with different mechanisms of action in combination is theoretically an attractive approach for treatment, either simultaneously, as sequential combination therapy (add-on), or even as an immediate switch from one agent to the other. Different NAs have also been combined in certain clinical situations. At present, several studies have confirmed certain virological advantages to combination therapies, but pivotal prospective studies demonstrating long-term clinical benefit to patients are still missing. Therefore, combination treatment, especially with PEG-IFN plus NAs, is not indicated and was not recommended by the European Association for the Study of the Liver Clinical Practice Guidelines written in 2012, while the guidelines for the use of combination NAs is limited to very few clinical situations.
目前，慢性乙型肝炎的抗病毒治疗可分为两类治疗药物：聚乙二醇干扰素α（PEG-IFN）和核苷（酸）类似物（NAs）。NAs 的主要优点是耐受性好，抗病毒活性强，治疗应答率高。PEG-IFN 的优点包括疗程有限、无耐药性以及有机会获得治疗后的持久应答。这两种具有不同作用机制的抗病毒药物联合使用在理论上是一种有吸引力的治疗方法，既可以同时使用，也可以序贯联合治疗（加用），甚至可以立即从一种药物转换为另一种药物。在某些临床情况下，也已经联合使用了不同的 NAs。目前，一些研究已经证实联合治疗具有一定的病毒学优势，但仍缺乏能够证明对患者具有长期临床获益的关键性前瞻性研究。因此，联合治疗，尤其是 PEG-IFN 加 NAs，目前并不被推荐，也未被 2012 年发表的欧洲肝脏研究学会临床实践指南所推荐，而联合使用 NAs 的指南仅限于极少数临床情况。
