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Objective To compare the efficacy and safety of entecavir versus adefovir dipivoxil in the treatment of HBeAg positive chronic hepatitis B ( CHB) . Methods Ninety?six cases with HBeAg positive CHB were divided into ETV group and ADV group according to different medication. In addition to conventional treatment,ETV group received entecavir 0. 5 mg/d,ADV group received adefovir dipivoxil 10 mg/d. HBV DNA negative conversion rate,alanine aminotransferase ( ALT) recurrence rate and HBeAg negative conversion rate in 24 weeks,48 weeks and 96 weeks were compared as well as the adverse reactions and liver function in 96 weeks. Results HBV DNA negative conversion rates in ETV group were significantly higher than those in ADV group in 24 weeks,48 weeks and 96 weeks (24 weeks:64. 6％(31/48) vs. 41. 7％(20/48);48 weeks:83. 3％(40/48) vs. 52. 1％(25/48);96 weeks:97. 9％(47/48) vs. 62. 5％(30/48),χ2 =5. 06,10. 72,18. 96,P<0. 05) . ALT recurrence rates in ETV group were significantly higher than those in ADV group at 24 weeks,48 weeks ( 24weeks:77. 1％( 37/48 ) vs. 54. 2％( 26/48 );48weeks:85. 4％( 40/48 ) vs. 62. 5％( 30/48 ) ,χ2=5. 59,6. 54,P<0. 05). There was no significant difference in ALT complication rate at 96 week(χ2=0. 71,P>0. 05) . There was no significant difference in HBeAg negative conversion rate between the two groups through treatment(χ2=0. 07, 0. 22, 0. 44, P>0. 05 ) . After 96 weeks, ALT in both groups decreased significantly ( t =13. 56,11. 85,P<0. 05) ,while ALT in ETV group was significantly lower than that in ADV group ( ( 31. 8 ±8. 6) U/L vs. (38. 5±7. 5) U/L,t=4. 07,P<0. 05). AST in both groups decreased significantly(t=41. 27, 33. 68,P<0. 05),while AST in ETV group was significantly lower than that in ADV group ( (30. 3±6. 5) U/L vs.(37.6±7.1)U/L,t=5.25,P<0.05).TBIL in both groups decreased significantly(t=28.92,22.23,P<0. 05),while TBIL in ETV group was significantly lower than that in ADV group ( (13. 5±3. 3) μmol/L vs. (18. 7±3. 9) μmol/L,t=7. 05,P<0. 05). GGT in both groups decreased significantly (t=16. 99,13. 97,P<0.05),while GGT in ETV group was significantly lower than that in ADV group ( (35.6±10.4)U/L vs. (59. 7±12. 5)U/L,t=10. 27,P<0. 05). There was no significant difference in adverse reaction between the two groups (χ2=1. 96,P>0. 05) . Conclusion Entecavir has a higher rate of HBV DNA negative conversion rate, ALT recurrence rate and HBeAg negative conversion rate in the treatment of HBeAg positive CHB. It is an ideal antiviral drug.
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Objective To systematically evaluate the efficacy and safety of nucleo(s)tide analogues (NAs)sequen-tial/NAs sequential combined with pegylated interferon (Peg-IFN)for the treatment of HBeAg-positive chronic hepatitis B(CHB).Methods PubMed,Cochrane Library,Embase,and Chinese Medical databases (CNKI,Wan-fang and VIP)from database establishment to March 25,2017 were retrieved,randomized controlled trials of NAs sequential/sequential combined with Peg-IFN for the treatment of CHB after application of NAs to achieve virologic response were included in study,Meta analysis was performed by RevMan 5.3 software,HBeAg seroconversion rate and HBsAg negative conversion rate at the end of treatment were compared.Results Nine studies were eventu-ally included,4 were about NAs sequential Peg-IFN,5 about NAs sequential combined with Peg-IFN.At the end of treatment,compared with using NAs monotherapy for antiviral treatment,NAs sequential/sequential combined with Peg-IFN therapy can improve HBeAg seroconversion rate(31.2% vs 11.7%;OR,3.69 [95%CI ,2.43 -5.60];P < 0.01 )and HBsAg negative conversion rate(11.5% vs 0.5%;OR,9.31 [95%CI ,2.72 - 31.89];P <0.01).According to the results of subgroup analysis,HBeAg seroconversion rate in NAs sequential Peg-IFN therapy group was higher than control group (25.3% [42/166]vs 10.0% [17/170];OR,3.1 [95%CI ,1.66 -5.79];P <0.01);HBeAg seroconversion rate in NAs sequential combined with Peg-IFN therapy was higher than control group (36.8%[63/171]vs 13.5%[23/171];OR,4.24[95%CI ,2.41 -7.46];P <0.01).Sequential/se-quential combination therapy showed more adverse reaction,most of which can be tolerated or improved after symp-tomatic treatment.Conclusion For the treatment of HBeAg-positive CHB,after application of NAs to achieve viro-logic response,NAs sequential/sequential combined with Peg-IFN therapy for 48 weeks can significantly increase HBeAg seroconversion rate and HBsAg negative conversion rate.
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OBJECTIVE:To observe the clinical efficacy and safety of recombinant human interferon α2b (rhIFN α2b) combined with bozhi glycopeptides or thymopentin in the treatment of chronic hepatitis B (CHB).METHODS:Ninety HBeAg-positive CHB patients were selected from our hospital during Jan.2014-Jan.2015 and then randomly divided into group A,B,C,with 30 cases in each group.Group A was given rhINF α2b for injection (Pseudomonas) 5 million IU subcutaneously,qod;group B was additionally given Bozhi glycopeptides injection 4 mL added into 5％ Glucose injection 250 mL,ivgtt,qd,on the basis of group A;group C was additionally given Thymopentin for injection 2 mg added into 5％ Glucose injection 250 mL,ivgtt,qd,on the basis of group A.Three groups were treated for 24 weeks.The rate of ALT recovering to normal,negative rate of HBeAg,transformation rate of HBeAg/anti-HBeAg serum,negative rate of HBV-DNA and the decrease of HBsAg and HBV-DNA were compared among 2 groups after 4,8,12,24 weeks of treatment.The occurrence of ADR was recorded.RESULTS:After 4,8,12 weeks of treatment,there was no statistical significance in the rate of ALT recovering to normal,negative rate of HBeAg,transformation rate of HBeAg and the decrease of HBsAg among 3 groups (P＞0.05).After 4 weeks,negative rate of HBV-DNA in group B,C were significantly higher than group A;the decrease of HBV-DNA in group C were more significant than group A and B,with statistical significance (P＜0.05).After 8,12 weeks of treatment,the negative rate of HBV-DNA and the decrease of HBV-DNA in group B,C were significantly higher than group A,with statistical significance (P＜0.05);but there was no statistical signifi cance between group B and C (P＞0.05).After 24 weeks of treatment,there was no statistical significance in the rate of ALT recovering to normal,transformation rate of HBeAg,the decrease of HBsAg and negative rate of HBsAg among 3 groups (P＞0.05).The negative rate of HBsAg,negative rate of HBV-DNA and the decrease of HBV-DNA in group B,C were significantly higher than group A,with statistical significance (P＜0.05);there was no statistical significance between group B and C (P＞0.05).There was no statistical significance in the incidence of ADR among 3 groups(P＞0.05).CONCLUSIONS:rhIFN α2bcombined with bozhi glycopeptides or thymopentin shows good inhibitory effect on CHB,therapeutic efficacies of them are similar in the rate of ALT recovering to normal,but transformation rate of HBeAg,the decrease of HBsAg and negative rate of HBeAg.
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OBJECTIVE:To observe therapeutic efficacy and safety of entecavir combined with long-acting interferon in the treatment of HBeAg positive chronic hepatitis B (CHB).METHODS:A total of 140 patients with HBeAg positive CHB selected from our hospital during May 2013-May 2015 were divided into observation group and control group according to random number table,with 70 cases in each group.Both groups received routine liver-protecting treatment;control group was additionally given Peginterferon α-2b injection 80 μg subcutaneously,once a week;observation group was additionally given Entecavir dispersible tablets 0.5 mg,po,qd,on the basis of control group.Both groups received treatment for consecutive 50 weeks.Clinical efficacies,liver function indexes before and after treatment,virological efficacies and the occurrence of ADR of 2 groups were observed.RESULTS:Each 5 cases withdrew from the study in 2 groups,and 130 cases (65 cases in each group) completed the study.Total response rate of observation group was 90.8％,which was significantly higher than 76.9％ of control group,with statistical significance (P＜0.05).Before treatment,there was no statistical significance in the levels of ALT,AST,ALB or TBIL between 2 groups (P＞0.05).After treatment,the levels of ALT,AST and TBIL in 2 groups were decreased significantly,while ALB level was increased significantly,the observation group was significantly better than the control group,with statistical significance (P＜0.05).After 50 weeks of treatment,the negative conversion rate of HBV-DNA,HBeAg serology conversion rate and ALT normalizing rate of observation group were significantly higher than those of control group,and virologic breakthrough rate was significantly lower than control group,with statistical significance (P＜0.05).No severe ADR was found in 2 groups.There was no statistical significance in the incidence of ADR (P＞0.05).CONCLUSIONS:The entecavir combined with long-acting interferon show defmite therapeutic efficacy for HBeAg positive CHB,inhibit the replication of HBV and improve liver function of patients with good safety.
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Objective To systematically evaluate the efficacy and safety of nucleo(s)tide analogues (NAs)sequen-tial/NAs sequential combined with pegylated interferon (Peg-IFN)for the treatment of HBeAg-positive chronic hepatitis B(CHB).Methods PubMed,Cochrane Library,Embase,and Chinese Medical databases (CNKI,Wan-fang and VIP)from database establishment to March 25,2017 were retrieved,randomized controlled trials of NAs sequential/sequential combined with Peg-IFN for the treatment of CHB after application of NAs to achieve virologic response were included in study,Meta analysis was performed by RevMan 5.3 software,HBeAg seroconversion rate and HBsAg negative conversion rate at the end of treatment were compared.Results Nine studies were eventu-ally included,4 were about NAs sequential Peg-IFN,5 about NAs sequential combined with Peg-IFN.At the end of treatment,compared with using NAs monotherapy for antiviral treatment,NAs sequential/sequential combined with Peg-IFN therapy can improve HBeAg seroconversion rate(31.2% vs 11.7%;OR,3.69 [95%CI ,2.43 -5.60];P < 0.01 )and HBsAg negative conversion rate(11.5% vs 0.5%;OR,9.31 [95%CI ,2.72 - 31.89];P <0.01).According to the results of subgroup analysis,HBeAg seroconversion rate in NAs sequential Peg-IFN therapy group was higher than control group (25.3% [42/166]vs 10.0% [17/170];OR,3.1 [95%CI ,1.66 -5.79];P <0.01);HBeAg seroconversion rate in NAs sequential combined with Peg-IFN therapy was higher than control group (36.8%[63/171]vs 13.5%[23/171];OR,4.24[95%CI ,2.41 -7.46];P <0.01).Sequential/se-quential combination therapy showed more adverse reaction,most of which can be tolerated or improved after symp-tomatic treatment.Conclusion For the treatment of HBeAg-positive CHB,after application of NAs to achieve viro-logic response,NAs sequential/sequential combined with Peg-IFN therapy for 48 weeks can significantly increase HBeAg seroconversion rate and HBsAg negative conversion rate.
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To observe the clinical efficacy of spleen, liver and kidney-strengthening formula combined with polyethylene glycol interferon in the treatment of HBeAg positive chronic hepatitis B(HP-HBV).One hundred and twenty-six patients with HP-HBV, who were treated in the hospital from June 2012 to December 2014, were selected and injected with polyethylene glycol interferon α-2a(or α-2b). The treatment course for the patients lasted for 24 weeks. Base on the level of HBV-DNA, patients are divided into response group and poor response group. According to random number table, the poor response group were randomized into control group and test group. Patients in the control group were injected with polyethylene glycol interferon α-2a(or α-2b), and patients in the test group were treated with spleen, liver and kidney-strengthening formula combined with polyethylene glycol interferon. Clinical efficacies of the 2 groups were observed, and changes in the level of HBeAg, ALT and HBV-DNA were observed before treatment and at the 24th week after treatment, and virological and serological response, biochemical responses, integral clinical symptoms and signs, adverse reactions were observed after 48 weeks of treatment.After 24 weeks of treatment, the response group was significantly better than the poor response group in HBeAg, ALT and the level of HBV-DNA(P<0.05). After 48 weeks of treatment, there was statistical significance in HBV-DNA negative conversion rate, HBeAg negative conversion rate between the 2 groups(P<0.05), and the test group was better in the two indicators. And the test group was significantly lower than the control group in clinical symptoms and signs score at the 48th week after treatment(P<0.05), with a significantly lower adverse reaction rate than the control group(P<0.05).Combination of spleen, liver and kidney-strengthening formula and polyethylene glycol interferon α-2a was effective and safe in the treatment of chronic hepatitis B, and so worth promoting in clinic.
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BACKGROUND/AIMS: Despite the potent suppression of the hepatitis B virus with modern antiviral agents, only a minority of HBeAg-positive patients achieve hepatitis B e antigen seroconversion. We aimed to explore the potential efficacy of combination therapy consisting of pegylated interferon (p-IFN) and an oral antiviral agent in patients with HBeAg-positive chronic hepatitis B. METHODS: The treatment protocol consisted of p-IFN-α-2a at 180 μg/wk for 48 weeks, with either entecavir or tenofovir added 8 weeks after the initiation of p-IFN and continued for at least 6 months after HBe seroconversion was achieved. RESULTS: To date, 10 patients have been treated under the protocol (eight adults, mean age 36±8 years; two adolescents, aged 12 and 16 years). All eight adult patients experienced loss of HBeAg at a mean of 72.3±66.9 weeks, including six patients who also developed anti-HBe and one patient who had HBs seroconversion. Although both adolescents remain on therapy, one adolescent had HBs seroconversion without HBe seroconversion. A total of nine of our 10 patients experienced a favorable serological transition. CONCLUSIONS: The combination of p-IFN and a modern oral antiviral agent may be more effective than monotherapy with either class of agent in the treatment of HBeAg-positive chronic hepatitis B patients.
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Adolescent , Adult , Humans , Antiviral Agents , Clinical Protocols , Hepatitis B , Hepatitis B e Antigens , Hepatitis B virus , Hepatitis B, Chronic , Hepatitis, Chronic , Interferons , Seroconversion , TenofovirABSTRACT
Objective To explore the combination of lamivudine and adefovir dipivoxiltreatment in HBeAg positive patients with inappropriate timing of decompensated hepatitis B cirrhosis.Methods Make a retrospective analysis of HBeAg positive patients with decompensated hepatitis B cirrhosis of the liver our hospital in 2014 January ~2015 January were,100 cases of initial treatment, 50 patients given lamivudine plus adefovir dipivoxil resistance as control group,50 cases patients given lamivudine plus adefovir dipivoxil combined as the observation group, compared two groups of clinical curative effect of treatment.Results Observation group after treatment in patients with HBeAgseroconversion rate of 26.00% was significantly higher than that in control group 4.00% (P<0.05);after 12 weeks of treatment in the observation group (9.63 ±1.42), 24 weeks(8.57 ±1.45), 48 weeks(7.43 ±1.57) Child-Pugh grading score was significantly lower than the control group(9.74 ±1.21),(9.45 ±1.33)(8.57 ±1.04)(P <0.05); level of HBV-DNA after treatment in the observation group (2.23 ±1.25) was significantly lower than that of the control group(5.18 ± 1.63), and the Patients in the observation group (2.23 ±1.25)HBV-DNA load in serum was significantly lower than that before treatment(6.47 ± 1.55)(P<0.05).Conclusion patients with decompensated hepatitis B cirrhosis with combination of lamivudine and adefovir dipivoxil treatment, the clinical efficacy is more significant, HBeAg seroconversion rate is increased , the score of Child-Pugh become low and improve liver reserve function, reduce HBV-DNA load in serum.
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Objective To investigate the clinical efficacy and the influence on T cell subsets of telbivudine in the treatment of HBeAg -positive chronic hepatitis B , guide clinical treatment .Methods 70 patients HBeAg -positive chronic hepatitis B in our hospital were randomly divided into the telbivudine group which were received telbi -vudine 600mg/d and lamivudine group which were received lamivudine 100mg/d,35 cases of each group ,both group had been treated for 48 weeks,the liver function (ALT,AST) were detected for making a statistics of ALT normaliza-tion,the serum were extracting for detecting HBV -DNA and making a statistics of HBV -DNA negative rate by PCR,the HbeAg were detected for making a statistics of HBeAg seroconversionby ECLIA ,T cell subsets ( CD3+,CD4+, CD8+,CD4+/CD8+) were detected by flow cytometry ,observed adverse events .Results The ALT,AST,HBV-DNA of the telbivudine group and lamivudine group after treatment were (36.04 ±7.62)U/L and (63.53 ±14.13)U/L, (34.26 ±8.51)U/L and (55.31 ±15.48)U/L,(2.22 ±0.73)copies/mL and (3.28 ±0.95)copies/mL,all indi-cators significantly lower than before treatment (t =24.826,18.564,7.495 and 17.413,13.331,5.442,all P<0.05),and the ALT,AST of the telbivudine group were significantly lower than the lamivudine group ( t=3.867, 3.774,3.498,all P<0.05).The ALT normalization,HBV-DNA negative rate,HBeAg seroconversion rate of the telbivudine group and lamivudine group were 97.14%and 74.29%,94.29%and 68.57%,62.86%and 37.14%, telbivudine group,the telbivudine group were significantly higher than that of lamivudine group (χ2 =7.467,7.652, 4.629,all P<0.05).The CD3+,CD4+,CD4+/CD8+of telbivudine group and lamivudine group after treatment were (66.3 ±3.8)%and (60.6 ±3.5)%,(38.8 ±5.4)% and (35.2 ±4.4)%,(1.33 ±0.16)% and (0.95 ±0.11)%,all indicaitons significantly higher than before treatment ( t =5.442,6.173,3.753 and 3.404,3.635, 3.222,all P <0.05),the telbivudine group were significantly higher than lamivudine group (t =3.473,3.207, 3.422,all P<0.05).Conclusion The telbivudine has better efficacy than the lamivudine in the treatment of HBeAg-positive chronic hepatitis B because of enhancing immune function ,can improves ALT normalization ,HBV-DNA negative rate and HBeAg seroconversion rate ,inhibit HBV replication .
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Aunque el objetivo óptimo del tratamiento de la Hepatitis B, sería la erradicación del virus, con las terapias con que contamos, en la actualidad, esto se consigue en un porcentaje mínimo de los pacientes. Por lo tanto, según el conocimiento actual, queda claro que el tratamiento que genera y logra mantener una supresión de larga duración del HBV DNA en niveles indetectables, reduce la incidencia de enfermedad hepática avanzada y hepatocarcinoma y este debería ser el objetivo que se plantee al tratar a los pacientes. Para la decisión de qué pacientes tratar debe considerarse su perfil clínico, perfil serológico, bioquímico y valores de carga viral. En algunas ocasiones, el clínico completará el estudio con una biopsia hepática. Hay tres grupos de pacientes por considerar cuándo se evalúa el paciente para darle tratamiento y todos tienen criterios distintos que guiarán la decisión del médico tratante, a saber: pacientes con hepatitis crónica HbeAg positivo, pacientes con hepatitis crónica HbeAg negativo, pacientes con enfermedad hepática avanzada.
Even though the optimum objective of hepatitis B treatment would be the eradication of the virus, therapies available nowadays only get this result on a minimum percentage of patients. Therefore, according to current knowledge, it is clear that the treatment that generates and keeps a long term suppression of HBV DNA at undetectable levels, reduces incidence of advanced liver disease and hepatocarcinoma, and this should be the objective when treating patients. When deciding which patients to treat, it should be considered their clinical, serological, and biochemical profiles, as well as the values of viral burden. Sometimes, the physician will finish the research with a hepatic biopsy. There are three groups of patients to be considered when deciding who to treat and all of them have different criteria that will guide the decision of the physician. The three groups include patients with: Chronic hepatitis HbeAg positive, chronic hepatitis HbeAg negative, and Advanced Liver disease.
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Humans , Hepatitis B, Chronic , Hepatitis B, Chronic/drug therapyABSTRACT
5000 copy/ml were both significantly higher than those in the controls.The levels of HBV-DNA positive in cultured supernatants of PBMC from suffering grave hepatitis B were higher than those in the sera by qualitative PCR of the same period.They were similar between the positive rate of quantitative PCR of HBV-DNA in sera and FQ-PCR in cultured supernatants of PBMC from hepatitis B types.They were not obviously related with the levels of ALT and TBiL.Conclusions The IL-12 and ? IFN secretion increased when the HBV-DNA of PBMC from carriers of HBeAg were at high-reproducing state.The HBV-DNA positive rate in cultured supernatants of PBMC of grave hepatitis detected by FQ-PCR was higher than that in sera by qualitative PCR.
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BACKGROUND: Although the development of antibodies(anti-HBs) against hepatitis B surface antigen(HBsAg) generally leads to the clearance of the infecting hepatitis B virus(HBV), anti-HBs reactivity has been reported in patients with chronic hepatitis. Some reports suggested that concurrent presence of HBsAg and anti-HBs was a common serologic pattern in HBV carriers, however, the others insisted concurrence was associated with evidence of viral replication and features of active inflammation. This study was to investigate the frequency and significance of concurrent presence of HBsAg and anti-HBs among Korean HBsAg-positive patients. METHODS: HBV serological markers were analyzed by Abbott Axym. Anti-HBs titer was assessed quantitatively using 6 standard calibrators(0, 10, 50, 100, 500 & 1,000 mIU/mL), and reported as positive when more than 10 mIU/mL. RESULTS: Of 959 consecutive HBsAg-positive patients who had simultaneous anti-HBs determinations, HBsAg and anti-HBs were found concurrently in 31(3.2%). Anti-HBs was quantitated 10-100 mIU/mL in 25(80.6%) and more than 100 mIU/mL in 6(19.4%) among 31 HBsAg-positive patients with concurrent presence of anti-HBs. HBeAg positive rate of concurrent HBsAg/anti-HBs-positive patients(15/22 or 68.2%) was higher than that of HBsAg-positive patients without anti-HBs(227/562 or 40.4%). Of 31 HBsAg-positive patients with concurrent anti-HBs, 15 were patients with chronic hepatits, 5 with primary hepatocellular carcinoma and 2 with liver cirrhosis. CONCLUSIONS: Concurrent HBsAg/anti-HBs-positive patients were found in about 3% of Korean HBsAg-positive patients and their anti-HBs titers were less than 100 mIU/mL in 80% of concurrent HBsAg/anti-HBs-positive patients. In patients with chronic hepatits B who possessed HBsAg and anti-HBs above 100 mIU/mL, infections of HBV variants with mutations in the envelope gene might be suspected.