Clin Gastroenterol Hepatol:口服联合抗病毒治疗HCV基因4型感染是否安全有效?

2017-06-13 闫盈盈 吴刚 环球医学

2017年6月,发表在《Clin Gastroenterol Hepatol》的一项由西班牙科学家进行的研究考察了口服联合抗病毒治疗丙型肝炎病毒(HCV)基因4型感染在真实世界中的有效性和安全性。

2017年6月,发表在《Clin Gastroenterol Hepatol》的一项由西班牙科学家进行的研究考察了口服联合抗病毒治疗丙型肝炎病毒(HCV)基因4型感染在真实世界中的有效性和安全性。

HCV基因4型感染患者在二代直接作用的抗病毒药物(DAA)的临床试验中研究不多。需要更多的数据帮助指导治疗决策。因此,研究人员考察了常规实践中,DAA在基因4型感染的患者中的有效性和安全性。

该队列研究中,研究人员鉴别出纳入到国家数据库中的接受ombitasvir/paritaprevir/利托那韦(OMV/PTVr)+利巴韦林(RBV)治疗(122人)或ledipasvir/sofosbuvir(LDV/SOF)±RBV治疗(130人)的HCV基因4型感染患者,并进行了前瞻性随访。研究人员分析了人口统计学、临床和病毒学数据和严重不良事件(SAE)。治疗组间患者的基线特征存在差异,意味着数据不能进行直接比较。

OMV/PTVr+RBV和LDV/SOF±RBV组,治疗后12周时的整体持续病毒学应答(SVR12)分别为96.2%和95.4%。肝硬化患者中,SVR12分别为91.2%和93.2%。根据两组纤维化的程度,SVR12没有显着性差异(P分别为0.243和0.244)。多变量分析中,基线白蛋白<3.5g/dL(OMV/PTVr)和胆红素>2mg/dL(两组)都与未能实现SVR显着相关(P<0.05)。OMV/PTVr+RBV组SAE发生率和SAE相关停药率分别为5.7%和2.5%,LDV/SOF±RBV组分别为4.6%和0.8%。

真实世界中,肝硬化和非肝硬化的HCV基因4型患者中,基于DAA的方案恢复了较高的SVR12率,与临床试验中的有限数据相当。两种方案的安全性特征都较好,并与其他HCV基因型报道的相当。

原始出处:

Crespo J, Calleja JL, et al. Real-World Effectiveness and Safety of Oral Combination Antiviral Therapy for Hepatitis C Virus Genotype 4 Infection. Clin Gastroenterol Hepatol. 2017 Jun;15(6):945-949.e1. doi: 10.1016/j.cgh.2017.02.020. 

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    2018-03-08 许安
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  5. 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    2017-06-15 ymljack
  6. 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    2017-06-15 yahu
  7. 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  8. 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createdBy=97bd1338592, createdName=清风拂面, createdTime=Wed Jun 14 16:51:32 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210492, encodeId=5191210492ac, content=学习了,谢谢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48ce1618316, createdName=stupidox, createdTime=Wed Jun 14 07:02:40 CST 2017, time=2017-06-14, status=1, ipAttribution=)]
    2017-06-15 gwc384
  9. 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createdBy=97bd1338592, createdName=清风拂面, createdTime=Wed Jun 14 16:51:32 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210492, encodeId=5191210492ac, content=学习了,谢谢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48ce1618316, createdName=stupidox, createdTime=Wed Jun 14 07:02:40 CST 2017, time=2017-06-14, status=1, ipAttribution=)]
    2017-06-14 清风拂面

    学习了,有收获

    0

  10. 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createdBy=97bd1338592, createdName=清风拂面, createdTime=Wed Jun 14 16:51:32 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210492, encodeId=5191210492ac, content=学习了,谢谢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48ce1618316, createdName=stupidox, createdTime=Wed Jun 14 07:02:40 CST 2017, time=2017-06-14, status=1, ipAttribution=)]
    2017-06-14 stupidox

    学习了,谢谢。

    0

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对于慢性HCV感染,直接作用抗病毒(DAA)治疗尽管已经表现出高SVR率,但仍会发生病毒学的失败,并且会导致潜在病毒耐药,这可能降低后续治疗的有效性。先前使用DAA方案治疗失败的患者,特别是使用过非结构蛋白5A抑制剂的患者的再治疗方案是有限的,目前这一领域的研究仍然未满足医疗需求。近来美国学者发表研究性文章于Hepatology,2期开放标记的研究(MAGELLAN-1)评估对于DAA治疗失败的H

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在欧美及中国等地,丙型肝炎(HCV)是其中一种日益严重的病毒感染。全世界约有1.85亿人感染丙型肝炎病毒;中国这个拥有13亿人口的亚洲大国总感染率为3.2%,换言之,在中国目前有多达4000万人感染了HCV病毒,而其中大约95%的患者感染五个主要的HCV病毒类型,包括:1b,2a,3a,3b和6a。经过几十年的研究,数种用于治疗丙型肝炎的药物已获批上市,并且有更多此类药物正处于各期临床试验之中

Am J Gastroenterol:老年HCV患者无干扰素治疗方案效果及耐受性研究

对于老年患者,无干扰素治疗HCV方案的持续病毒应答率与其他年龄段无显著差异。基线白蛋白水平低(≤3.5g/dl)是唯一的治疗失败预测指标,但不良事件率和死亡率随患者年龄增加而增大。需谨慎选择老年HCV患者抗病毒治疗方案

Liver Int:直接作用抗病毒治疗减少慢性丙型肝炎肝硬化患者的肝细胞癌复发

直接作用抗病毒(DAA)药物治疗丙型肝炎病毒(HCV),具有高持续性病毒学应答(SVR)率和非常少的副作用,大大提高了对HCV感染的治愈率。 DAA暴露是否影响晚期纤维化患者的肝细胞癌(HCC)复发尚待澄清。本研究选取68例持续HCV感染者,他们是首次被诊断为HCC并正处于缓解期,给予其DAA组合治疗或无DAA治疗。所有患者均为肝硬化。中位年龄62岁, 76%为男性。23名患者(34%)接受DAA

Hepatology:感染HCV 2、3型青少年中索非布韦和利巴韦林的治疗效果

患有慢性丙型肝炎病毒(HCV)感染的儿童治疗方案有限。本研究评估联合口服索非布韦和利巴韦林在丙型肝炎病毒基因2型或3型,年龄在12-17岁青少年中的治疗效果。近期美国科学家发表研究性文章于著名肝脏病学杂志Hepatology以探讨这一问题。研究纳入52例接受索非布韦(400 mg、1次/天)和利巴韦林(2次/天)治疗12周(HCV基因2型)或24周(HCV基因3型)的患者。第7天采集最初入组10例

J Hepatol:肝细胞癌降低直接作用抗病毒药物治疗丙型肝炎的成功率

全口服直接作用抗病毒药物(DAA)治疗丙型肝炎(HCV),适应症包括肝硬化伴有肝细胞癌(HCC)患者。然而HCV + HCC患者使用DAAs的数据尚比较有限。本研究的目的是评估现在或曾经患有HCV的肝硬化患者与没有HCC的肝硬化患者使用全口服DAA方案的疗效。芝加哥学者日前对其机构2014年1月至2015年11月期间,DAAs治疗的HCV肝硬化患者做了一回顾性队列分析。共纳入421例HCV +肝硬