Response-guided treatment of cirrhotic chronic hepatitis B patients: multicenter prospective study.

Autor:	Gu EL; Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China., Yu YQ; Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China., Wang JL; Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China., Ji YY; Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China., Ma XY; Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China., Xie Q; Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China., Pan HY; Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China., Wu SM; Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China., Li J; Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China., Chen CW; Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China., Xu XW; Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China., Wang YE; Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China., Yao GB; Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China., Wang H; Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China., Zhang WH; Er-Li Gu, Yan-Yan Ji, Yue-Er Wang, Guang-Bi Yao, Hong Wang, Department of Gastroenterology and Hepatology, Jing'an District Central Hospital, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China.
Jazyk:	angličtina
Zdroj:	World journal of gastroenterology [World J Gastroenterol] 2015 Jan 14; Vol. 21 (2), pp. 653-60.
DOI:	10.3748/wjg.v21.i2.653
Abstrakt:	Aim: To observe the effect of response-guided add-on therapy with adefovir (ADV) and lamivudine (LAM) in cirrhotic hepatitis B (CHB) patients. Methods: A total of 100 patients with CHB and cirrhosis were divided into three arms according to hepatitis B virus (HBV) DNA level after 24 wk LAM monotherapy: Arm A (complete response, HBV DNA ≤ 60 IU/mL, n = 49), Arm B (partial response, HBV DNA: 60-2000 IU/mL, n = 31) and Arm C (inadequate response, HBV DNA > 2000 IU/mL, n = 20). ADV was added to LAM at week 48 in Arms A and B, but at week 24 in Arm C. Virological response, YMDD mutations, biochemical response, and liver function were evaluated. Results: Comparison of the three arms demonstrated that early complete virologic response at week 24 was associated with maintained viral suppression (undetectable rate of HBV DNA at week 144 was 95.96%, 66.67% and 35.29%, respectively, P = 0.000) and reduced YMDD mutations (mutation rate at week 144 was 0%, 3.23% and 15%, respectively, P = 0.015) after 144 wk treatment. For patients who failed to achieve complete virological response at week 24, switching to combination therapy further decreased HBV DNA level by 1 log10 IU/mL. All three arms obtained biochemical benefits including decline of alanine aminotransferase and elevation of albumin. In patients who developed HBV DNA breakthrough for YMDD mutations, ADV add-on therapy did not induce further multiple drug resistance to LAM or ADV. Conclusion: Optimized response-guided add-on therapy of ADV and LAM maintains long-term suppression of HBV DNA and improves liver function in CHB patients with compensated liver cirrhosis.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu