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Objective@#To study the factors associated with efficacy of nucleos(t)ide analogues with sequential interferon in HBeAg positive chronic hepatitis B (CHB) patients.@*Method@#HBeAg positive CHB patients treated with nucleoside analogue (NA) treatment received PEG-IFN α-2a 180 μg subcutaneously once weekly.NA was continually used with PEG-IFNα-2a during the first 12 weeks. HBsAg/HBeAg level and HBV DNA load were observed in the sequential pre-treatment (baseline) period, 12 th, 24 th, 36 th, 48 th and 72 nd weeks of sequential therapy in all patients.@*Result@#Of the 56 HBeAg-positive CHB patients, 5 (23.1%) achieved HBsAg loss/seroconversion, the baseline HBsAg level in HBsAg loss/seroconversion group was lower than that of the patients in the group that did not achieve HBsAg loss/seroconversion (2.750 lg IU/ml vs. 3.699 lg IU/ml, t=0.955, P=0.000); the difference was statistically significant in HBsAg decreased at the 12 th, 24 th, 36 th, 48 th week in the course of sequential therapy (0.913 vs 0.149, 2.847 vs 0.189, 4.378 vs 0.248, 4.587 vs 0.274 lg IU/ml) (t=-2.950, P=0.040; t=-8.732, P=0.009; t=-8.483, P=0.001; t=-8.214, P=0.003); 11(19.6%) achieved HBeAg loss/ seroconversion, the HBeAg baseline level in HBeAg loss/seroconversion group was lower than the patients in the group that not achieved HBeAg loss/seroconversion (1.217 lgS/CO vs 1.884 lgS/CO, t=2.061, P=0.044); the difference was statistically significant in HBsAg, HBeAg decreased at 24 th, 36 th, 48 th week in the course of sequential therapy between the two groups (1.330 vs 0.205, 2.084 vs 0.258, 1.972 vs 0.284, lg IU/ml; 1.168 vs 0.455, 1.363 vs 0.461, 1.177 vs 0.447, lg S/CO) (t=2.238, P=0.049; t=2.619, P=0.025; t=2.278, P=0.048); (t=2.273, P=0.043; t=3.415, P=0.001; t=2.271, P=0.049).@*Conclusions@#To HBeAg-positive CHB, lower baseline HBsAg, HBeAg level and HBsAg, HBeAg decreased earlier were could predict easier achievement of HBs(e)Ag loss/seroconversion.
ABSTRACT
Objective@#To study the factors associated with efficacy of nucleos(t)ide analogues with sequential interferon in HBeAg negative chronic hepatitis B (CHB) patients.@*Methods@#HBeAg negative CHB patients with NA treatment received PEG-IFNα 2a 180 μg subcutaneously once weekly. NA was continually used with PEG-IFN 2a during the first 12 weeks. HBsAg level and HBV DNA load were observed in the sequential pre-treatment (baseline), 12th, 24th, 36th, 48th, 72nd and 96th weeks of sequential therapy in all patients.@*Results@#Of the 26 HBeAg negative CHB patients, 6 (23.1%) achieved HBsAg loss/seroconversion. The comparison between HBsAg loss/ seroconversion group and the group not achieved HBsAg loss/ seroconversion showed that the baseline HBsAg level in HBsAg loss/seroconversion group was 2.210 log10IU/ml, was lower than (t=-4.252, P=0.000) HBsAg-positive patients (3.385 log10IU/ml) in the groupp that not achieved HBsAg loss/seroconversion, the difference was statistically significant in HBsAg decreased at 72nd, 96th week in the course of sequential therapy (3.511 vs. 0.723log10IU/ml, 4.291 vs. 0.737 log10IU/ml) (t=6.712, P=0.000, t=13.319; P=0.000, 0.00); the difference was not statistically significant in age, gender and NA therapy time between the two groups; 12 (46.2%) of patients achieved sustained virologic response (SVR), the baseline of HBsAg level was 2.575 log10IU/ml, was less than (t=-4.319, P=0.000) the patients who did not achieve SVR (3.576 log10IU/ml), the difference was statistically significant in HBsAg decrease of each time in the course of sequential therapy between the two groups (0.612 vs. 0.088, 1.192 vs. 0.107, 1.566 vs. 0.167, 1.817 vs. 0.176, 2.424 vs. 0.193, 2.188 vs. 0.014, log10IU/ml) (t=3.109, 4.717, 4.500, 4.544, 5.560, 4.265, P=0.008, 0.010, 0.001, 0.001, 0.000, 0.003), the difference was not statistically significant in gender and NA therapy time, the difference was statistically significant in age (30.8 vs. 39.9 years) ( t=-2.219, P=0.038). Of 9 CHB patients whose baseline HBV DNA were positive, 5 patients (55.6%) had HBV DNA loss after sequential treatment, the patients whose HBV DNA loss with HBsAg decreased at 12th week in the course of sequential therapy, but there was no influence in the HBsAg decrease/loss after 12th week, the difference was not statistically significant in age, gender, NA therapy time, HBsAg and HBsAg decrease in the course of sequential therapy between HBV DNA-negative and HBV DNA-positive groups.@*Conclusions@#To HBeAg-negative CHB, patients with low baseline HBsAg (2 log10 IU/ml level) and significantly lower HBsAg decrease early were more likely to receive SVR. Among them, prolonged interferon therapy is easier to achieve HBsAg loss/seroconversion.
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OBJECTIVE:To provide reference for rational use of antiviral drugs for hepatitis B viral (HBV) in the clinic. METHODS:The application of antiviral drugs for HBV in a hospital during 2010-2014 was analyzed statistically in respects of con-sumption sum,DDDs,serial number ratio(B/A),etc. RESULTS:Total consumption sum of antiviral drugs for HBV in a hospital increased from 5 698 200 yuan to 20 115 600 yuan during 2010-2014,and annual average rate of growth (AARG) of entecavir 76.37%. The consumption sum of ordinary interferon decreased year by year,with AARG of -20.30%. Besides DDDs of ordinary interferon declined year by year,DDDs of all antiviral drugs for HBV showed a trend of increased year by year,among which the increase of entecavir was the most obvious,being 1 366.30%from 2010 to 2014. The B/A value of lamivudine,telbivudine and or-dinary interferon were equal to or close to 1 for consecutive 5 years,and the number of patients was well synchronized with con-sumption sum. CONCLUSIONS:Nucleoside (acid) analogues has become an important method of HBV antiviral treatment,and the drugs should be selected reasonably according to the specific condition of patients in clinical treatment,in order to improve the safety,effectiveness and economy of treatment.
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OBJECTIVE:To study the persistence of the effects of nucleoside (acid) analogues in the treatment of chronic hepatitis B (CHB) after drug withdrawal. METHODS:150 cases of CHB were selected and received nucleoside (acid) ana-logues for one year at least. They were divided into the standard group(n=56)and non standard group(n=87)according to the drug withdrawal standard stated in Guidelines for Prevention and Treatment of CHB,and followed up for one year except 7 cas-es of drug withdrawal who were followed up less than one year. HBV serum markers HBVM and HBV-DNA were detected quan-titatively in 2 groups. CHB recurrence,HBsAg disappearance and the change of HBV in serum were observed in 2 groups after drug withdrawal. RESULTS:The recurrence rate of CHB patients with HBeAg (+) in standard group and non standard group were lower than those with HBeAg(-),with statistical significance(P0.05);the total recurrence rate of standard group was lower than that of non standard group,with statistical sig-nificance(P0.05). Among sustained responders,HBsAg of 3 patients disappeared in standard group,including 2 cases of HBsAg seroconversion,1 case of no HBsAg seroconversion. Among patients with recurrent CHB,2 patients suffered from HBeAg(+)again in standard group,and 1 patient with HBeAg(-)developed liver cancer;5 patients suffered from HBeAg(+)again in non standard group,including 1 patient died and 1 patient with HBeAg(-)devel-oped liver cancer. CONCLUSIONS:Taking Guidelines for Prevention and Treatment of CHB as drug withdrawal standard,there still is a high recurrence rate after stopping nucleoside(acid)analogues;the recurrence rate of patients with HBeAg(-)is high-er than those with HBeAg(+),and that of patients in non standard group is higher than in standard group. The types of nucleo-side(acid)analogues do not influence recurrence rate after drug withdrawal.