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富马酸替诺福韦二吡呋酯联合聚乙二醇干扰素α-2a 治疗后乙型肝炎表面抗原消失:120 周分析。

Hepatitis B Surface Antigen Loss with Tenofovir Disoproxil Fumarate Plus Peginterferon Alfa-2a: Week 120 Analysis.

机构信息

Department of Internal Medicine, Yonsei University College of Medicine, Brain Korea 21 Plus Project for Medical Science, Seoul, Republic of Korea.

Hôpital Beaujon, University Paris-Diderot, Clichy, France.

出版信息

Dig Dis Sci. 2018 Dec;63(12):3487-3497. doi: 10.1007/s10620-018-5251-9. Epub 2018 Aug 22.

Abstract

BACKGROUND AND AIMS

Hepatitis B surface antigen (HBsAg) loss is the ideal clinical endpoint but is achieved rarely during oral antiviral treatment. A current unmet need in CHB management is achievement of HBsAg loss with a finite course of oral antiviral therapy, thereby allowing discontinuation of treatment. Significantly higher rates of HBsAg loss at 72 weeks post-treatment have been demonstrated when tenofovir disoproxil fumarate (TDF) was combined with pegylated interferon (PEG-IFN) for 48 weeks compared with either monotherapy. This analysis provides follow-up data at week 120.

METHODS

In an open-label, active-controlled study, 740 patients with chronic hepatitis B were randomly assigned to receive TDF plus PEG-IFN for 48 weeks (group A), TDF plus PEG-IFN for 16 weeks followed by TDF for 32 weeks (group B), TDF for 120 weeks (group C), or PEG-IFN for 48 weeks (group D). Efficacy and safety at week 120 were assessed.

RESULTS

Rates of HBsAg loss at week 120 were significantly higher in group A (10.4%) than in group B (3.5%), group C (0%), and group D (3.5%). Rates of HBsAg loss and HBsAg seroconversion in group A were significantly higher than rates in group C (P < 0.001 for both) or group D (HBsAg loss: P = 0.002; HBsAg seroconversion: P < 0.001).

CONCLUSIONS

The results of this analysis confirm the results from earlier time points which demonstrate the increased rate of HBsAg loss in patients treated with a finite course of PEG-IFN plus TDF compared with the rates in patients receiving either monotherapy.

摘要

背景和目的

乙肝表面抗原(HBsAg)清除是理想的临床终点,但在口服抗病毒治疗中很少实现。目前,慢性乙型肝炎管理中的一个未满足需求是通过有限疗程的口服抗病毒治疗实现 HBsAg 清除,从而允许停止治疗。与单药治疗相比,替诺福韦酯(TDF)联合聚乙二醇干扰素(PEG-IFN)治疗 48 周后,72 周时 HBsAg 清除率显著提高。本分析提供了 120 周时的随访数据。

方法

在一项开放性、活性对照研究中,740 例慢性乙型肝炎患者被随机分为 TDF 联合 PEG-IFN 治疗 48 周(A 组)、TDF 联合 PEG-IFN 治疗 16 周后再治疗 32 周(B 组)、TDF 治疗 120 周(C 组)或 PEG-IFN 治疗 48 周(D 组)。评估第 120 周的疗效和安全性。

结果

第 120 周时,A 组(10.4%)HBsAg 清除率显著高于 B 组(3.5%)、C 组(0%)和 D 组(3.5%)。A 组 HBsAg 清除率和 HBsAg 血清学转换率明显高于 C 组(均 P<0.001)或 D 组(HBsAg 清除率:P=0.002;HBsAg 血清学转换:P<0.001)。

结论

本分析结果证实了早期时间点的结果,即与接受单药治疗的患者相比,接受有限疗程 PEG-IFN 联合 TDF 治疗的患者 HBsAg 清除率更高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b951/6244971/9f8f66b02da5/10620_2018_5251_Fig1_HTML.jpg

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