Wei Xin, Fan Chao, Zhou Yun, Kang Wenzhen, Wang Jiuping, Sun Li, Wang Linxu, Peng Meijuan, Lian Jianqi, Jia Zhansheng, Hao Chunqiu
Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shannxi Province, China.
Hepat Mon. 2016 Jan 23;16(1):e31278. doi: 10.5812/hepatmon.31278. eCollection 2016 Jan.
There are limited options for chronic hepatitis B (CHB) patients who have poor responses to adefovir (ADV).
The aim of this study is to evaluate the effects of adding on telbivudine (LdT) or switching to pegylated interferon alfa-2a (PEG-IFN-α2a) as alternative rescue therapies for patients with poor responses to the initial ADV treatments.
Ninety-seven CHB patients with HBV DNA > 2 log10 copies/mL 48 weeks after ADV monotherapy were included in this study. Fifty-nine of these patients were treated with a combination of LdT plus ADV (LdT + ADV) daily, while thirty-eight patients were switched to PEG-IFN-α2a subcutaneous injections weekly for 48 weeks.
Both rescue strategies were proven to be safe and the majority of patients tolerated the therapies well. LdT + ADV led to more rapid reductions in viral loads than PEG-IFN-α2a monotherapy, with 2.14 (LdT + ADV) and 0.98 (PEG-IFN-α2a) log10 copies/mL decreases 48 weeks after rescue treatments, respectively (P < 0.00001). The rates corresponding to virological and biochemical responses were also elevated in patients who received the LdT + ADV combination therapy at the end of the observation period (88.1 vs. 68.4% for virological response, P = 0.017; 83.3 vs. 47.2%, P = 0.00045). However, the decline in the hepatitis B surface antigen (HBsAg) was more pronounced in PEG-IFN-α2a treated patients. Moreover, the cumulative rates of serological responses were higher in patients who switched to the PEG-IFN-α2a therapy.
Both add-on LdT and switching to PEG-IFN-α2a were satisfactory and optimal treatments for CHB patients with poor responses to ADV. Both rescue strategies resulted in significant reductions in serum viral load and ALT levels, and were associated with high rate of serological outcomes in our hospital.
对于对阿德福韦（ADV）反应不佳的慢性乙型肝炎（CHB）患者，治疗选择有限。
本研究旨在评估加用替比夫定（LdT）或换用聚乙二醇化干扰素α-2a（PEG-IFN-α2a）作为初始阿德福韦治疗反应不佳患者的替代挽救疗法的效果。
本研究纳入了97例接受阿德福韦单药治疗48周后HBV DNA>2 log10拷贝/mL的慢性乙型肝炎患者。其中59例患者每日接受LdT联合阿德福韦（LdT+ADV）治疗，38例患者换用聚乙二醇化干扰素α-2a皮下注射，每周1次，共48周。
两种挽救策略均被证明是安全的，大多数患者对治疗耐受性良好。LdT+ADV比聚乙二醇化干扰素α-2a单药治疗导致病毒载量下降更快，挽救治疗48周后分别下降2.14（LdT+ADV）和0.98（聚乙二醇化干扰素α-2a）log10拷贝/mL（P<0.00001）。在观察期末接受LdT+ADV联合治疗的患者中，病毒学和生化反应率也有所提高（病毒学反应率分别为88.1%和68.4%，P=0.017；83.3%和47.2%，P=0.00045）。然而，聚乙二醇化干扰素α-2a治疗的患者乙肝表面抗原（HBsAg）下降更为明显。此外，换用聚乙二醇化干扰素α-2a治疗的患者血清学反应的累积率更高。
加用LdT和换用聚乙二醇化干扰素α-2a对于对阿德福韦反应不佳的慢性乙型肝炎患者都是令人满意的最佳治疗方法。两种挽救策略均导致血清病毒载量和ALT水平显著降低，且在我院与高血清学结局率相关。
