确定标准派罗欣作为慢性丙型肝炎的治疗选择课件.ppt

* * * * * * * * * * * * * The data using IFN monotherapy to treat dual infection was very limited. Only sporadic cases had been reported. And frequently, such analysis was retrospective and not primarily focusing on treating patients with dual chronic hepatitis C and B. For example, Mazzella treated 7 pts with primary CH-B, who were later found to be also positive for HCV RNA. He used interferon 5MIU tiw for 6 months for these patients and none lost HCV RNA. From these data, you can see that the HCV RNA clearance rate was very low. This figure shows the End-of-FU HCV SVR rate between dually infected patients and HCV monoinfected patients. Again, the HCV SVR was comparable between two groups of patients. 64% versus 66%. * * * * * Study Design This was a Phase III, randomised, partially double-blind, multinational study conducted in 15 countries in accordance with international and local principles of GCP The trial was designed to compare the efficacy and safety of PEGASYS with/without lamivudine vs lamivudine alone in patients with HBeAg-positive CHB. This study represents the largest prospective study in HBeAg-positive CHB to date, and is the first and, currently, only study comparing a pegylated IFN with LAM monotherapy. * * * * * * * * * 派罗欣在白人还是亚洲人中，在e抗原阳性患者还是在阴性患者中均能清除HBsAg抗原 基线因素与派罗欣停药后应答相关吗? HBeAg－阳性研究 派罗欣III期临床研究以亚洲人为主 HBeAg-阴性研究 亚洲人 黑人 高加索人 其他 结论: 派罗欣是最佳选择 对HBeAg-阳性和阴性乙肝均适用，对所有基因型均适用 适用于愿意有限疗程的患者 在派罗欣治疗过程中监测HBsAg定量水平能抓住那些有应答的患者 为临床治愈而奋斗 派罗欣缔造 肝炎治疗成功 如何解释派罗欣在有限疗程之后发生迟发的HBsAg的清除? Graham Foster 伦敦, 英国 干扰素治疗: 维持持免疫的平衡 肝脏损坏的主要原因是由于人体免疫系统试图清除病毒失败的结果 干扰素 – 众多效果 抗病毒 免疫调节 共同结果导致人体产生 停药后持久的应答 有些病人可以坐在随访期 清除HBsAg IFN为基础的治疗应答者HBsAg清除率随时间升高 40% 60% 80% 0 10 20 30 40 50 60 70 80 90 5 10 15 累积HBsAg清除率(%) 治疗结束后年份 Moucari et al. J Hepatol 2009 IFN治疗结束后48周，HBeAg 血清转换以及HBV DNA检测不到的患者 HBeAg 阳性患者 对干扰素持续应答者随时间延长，HBsAg清除率上升