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替诺福韦酯治疗慢性乙型肝炎合并重度肝纤维化或代偿期肝硬化患者。

Tenofovir disoproxil fumarate therapy in patients with chronic hepatitis B and advanced fibrosis or compensated cirrhosis.

作者信息

Rao Huiying, Shang Jia, Xie Qing, Lian Jianqi, Gao Pujun, Shi Junping, Chen Xinyue, Wang Jiefei, Xu Min, Zhang Liaoyun, Zhao Yingren, Mao Qing, Wang Maorong, Zhao Wei, Zhang Zong, Jia Jidong, Tang Hong, Zhang Jiming, Zheng Xin, Liu Chang, Wei Lai

机构信息

Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China.

Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, Henan, China.

出版信息

ILIVER. 2022 Oct 12;1(3):145-153. doi: 10.1016/j.iliver.2022.08.006. eCollection 2022 Sep.

Abstract

BACKGROUND AND AIMS

Tenofovir disoproxil fumarate (TDF) is the first-line therapy for chronic hepatitis B. This interim analysis presents the efficacy and safety data for TDF at Week 144 in patients with chronic hepatitis B and advanced fibrosis or compensated cirrhosis from China.

METHODS

Patients were assessed for incidence of newly diagnosed hepatocellular carcinoma (HCC) and disease progression, liver stiffness measurement (LSM), virological suppression (serum hepatitis B virus DNA <20 IU/mL), alanine aminotransferase normalization, hepatitis B e antigen (HBeAg) loss and seroconversion, histological liver fibrosis score, and safety at Week 144.

RESULTS

Overall, 197 patients were enrolled. At Week 144, the incidence of newly diagnosed HCC was observed in 2.1% patients, and the incidence of disease progression was observed in 3.6% patients. The mean (standard deviation) change in LSM from baseline was -5.1 (5.85) kPa. Serum hepatitis B virus DNA <20 IU/mL was observed in 94.1% patients, alanine aminotransferase normalization in 33.5% patients, HBeAg loss in 35.6% patients, and HBeAg seroconversion in 14.4% patients. Among patients with stage F3 or F4 fibrosis at baseline by LSM, 38.3% patients regressed to stage F0/1, and 22.0% of patients regressed to stage F2 at Week 144. Overall, 67.7% patients experienced ≥1 adverse events, 13.8% patients experienced TDF-related adverse events, and 16.4% patients experienced serious (none were TDF-related).

CONCLUSIONS

At Week 144 of TDF treatment, low incidence of HCC and disease progression were reported. Virological suppression was observed in 94.1% patients, which was associated with fibrosis regression. No new safety events were identified.

摘要

背景与目的

替诺福韦酯(TDF)是慢性乙型肝炎的一线治疗药物。本中期分析展示了中国慢性乙型肝炎伴晚期纤维化或代偿期肝硬化患者在第144周时TDF的疗效和安全性数据。

方法

评估患者在第144周时新诊断肝细胞癌(HCC)的发生率、疾病进展情况、肝脏硬度值(LSM)、病毒学抑制(血清乙型肝炎病毒DNA<20 IU/mL)、丙氨酸氨基转移酶正常化、乙型肝炎e抗原(HBeAg)消失和血清学转换、肝脏组织纤维化评分以及安全性。

结果

共纳入197例患者。在第144周时,2.1%的患者出现新诊断的HCC,3.6%的患者出现疾病进展。LSM较基线的平均(标准差)变化为-5.1(5.85)kPa。94.1%的患者血清乙型肝炎病毒DNA<20 IU/mL,33.5%的患者丙氨酸氨基转移酶正常化,35.6%的患者HBeAg消失,14.4%的患者HBeAg血清学转换。基线时LSM为F3或F4期纤维化的患者中,38.3%的患者在第144周时纤维化程度降至F0/1期,22.0%的患者降至F2期。总体而言,67.7%的患者发生≥1次不良事件,13.8%的患者发生与TDF相关的不良事件,16.4%的患者发生严重不良事件(均与TDF无关)。

结论

在TDF治疗的第144周,报告的HCC和疾病进展发生率较低。94.1%的患者实现病毒学抑制,且与纤维化程度改善相关。未发现新的安全事件。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5512/12212702/7e10bec13c48/ga1.jpg

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