Borrego Izquierdo Yolanda, Gómez Fernández Encarnación, Monje Agudo Patricia, Jiménez Galán Rocío, Almeida-González Carmen V, Ferrit Martín Mónica, Morillo Verdugo Ramón
Pharmacy Service, Valme University Hospital, Seville, Spain.
Biostatistician, Valme University Hospital, Seville, Spain.
Eur J Hosp Pharm. 2016 Sep;23(5):278-282. doi: 10.1136/ejhpharm-2015-000822. Epub 2016 Feb 22.
There are currently five approved nucleos(t)ide analogues (NUCs) for the management of chronic hepatitis B (CHB): lamivudine, adefovir dipivoxil, telbivudine, entecavir, and tenofovir disoproxil fumarate.
To determine the persistence rates among patients receiving NUCs for CHB at weeks 48, 96 and 144, compare them in these periods, and analyse the evolution of treatment persistence.
We conducted a retrospective study that included patients with CHB who initiated antiviral therapy and were attended to by the pharmaceutical care office between January 2002 and December 2011. Patients included in a clinical trial or patients who did not collect their medication personally were excluded. There were two different analyses: a comparative analysis of the persistence rates in three periods (weeks 1-48, weeks 48-96, and weeks 96-144); and a Kaplan-Meier analysis to evaluate the evolution of persistence.
A total of 102 patients were included. Persistence rates were different in the three periods. They decreased during the course of the different periods, and the decline was more rapid between the first and second period. There were statistically significant differences in the non-persistence of the five drugs (p<0.005). Entecavir had the best profile of persistence, followed by tenofovir.
This study showed that high genetic barrier drugs had a better profile of persistence in the initial treatment of patients with CHB. Data seem to suggest entecavir may offer better persistence rates than tenofovir, and the persistence rates for all five medications dropped in weeks 48-96.
目前有五种已获批用于治疗慢性乙型肝炎（CHB）的核苷（酸）类似物（NUC）：拉米夫定、阿德福韦酯、替比夫定、恩替卡韦和富马酸替诺福韦二吡呋酯。
确定接受核苷（酸）类似物治疗慢性乙型肝炎患者在第48、96和144周时的持续治疗率，比较这些时期的持续治疗率，并分析治疗持续情况的演变。
我们进行了一项回顾性研究，纳入了2002年1月至2011年12月期间开始抗病毒治疗并在药学服务办公室接受治疗的慢性乙型肝炎患者。排除纳入临床试验的患者或未亲自领取药物的患者。有两种不同的分析：三个时期（第1-48周、第48-96周和第96-144周）持续治疗率的比较分析；以及评估持续治疗情况演变的Kaplan-Meier分析。
共纳入102例患者。三个时期的持续治疗率不同。在不同时期持续治疗率下降，且在第一个时期和第二个时期之间下降更快。五种药物的停药情况存在统计学显著差异（p<0.005）。恩替卡韦的持续治疗情况最佳，其次是替诺福韦。
本研究表明，高基因屏障药物在慢性乙型肝炎患者初始治疗中的持续治疗情况更好。数据似乎表明恩替卡韦的持续治疗率可能优于替诺福韦，且所有五种药物在第48-96周时持续治疗率均下降。
