【新整理】慢性乙型肝炎患者管理(英文版)-wenkub.com
2024-11-19 00:18 本頁(yè)面
【正文】 Yuen et al 2001,17,Patients with HBV DNA 20,000 copies/mL at 72 weeks (%),Serum HBV DNA level at 12 weeks, copies/mL,HBeAgnegative patients (n=176) treated with peginterferon alfa2a for 48 weeks,P0.001,Farci et al 2005,Viral Suppression with PegInterferon alfa2a Association with subsequent HBV DNA response,18,Profound, Early Viral Suppression Week 24 viral load and 2year outcomes? with telbivudine and lamivudine,QL=quantification limit (polymerase chain reaction (PCR)undetectable at 300 copies/mL by COBAS174。 Liaw et al 2004。 however, a standard ontreatment management approach does not exist To establish a new treatment paradigm, we should ask Does longterm suppression of HBV replication achieve the goals of treatment in CHB? Can the degree of ontreatment viral suppression predict outcomes? Does profound, early viral suppression at week 24 predict clinical outcomes? Can a Roadmap concept help achieve the goals of treatment in CHB?,4,Presentation Objectives,To explore the association between persistent viraemia and hepatitis disease progression To assess the relationship between the degree of viral suppression and clinical outcome To assess the role of early and effective viral load reduction and the association with clinical outcomes* To review an ontreatment management strategy – the roadmap concept – that may offer a valuable opportunity for enhanced treatment response,* For safety information on the products referred to, please refer to the Product Information.,Data Review: Associations of HBV DNA with Outcomes,i. Natural history studies,6,Correlation Between HBV DNA and Histologic Activity Index (HAI) in Untreated Patients,Review of 26 prospective clinical trials found a statistically significant correlation between viral load level and histological grading,Baseline HBV DNA level, log10 copies/mL,r=0.78。 P=0.0001,HAI at baseline,MommejaMarin et al 2003,7,Cirrhosis: Association with Baseline HBV DNA Taiwan natural history study,Iloeje et al 2006,8,Hepatocellular Carcinoma (HCC) Association with baseline HBV DNA: Taiwan natural history study,Cumulative incidence of HCC, %,HBV DNA at baseline, copies/mL,HBsAgpositive, untreated participants (n=3,653),Chen et al 2006,9,Evidence for Association Between HBV DNA and Clinical Outcomes,Natural history studies demonstrate Lower HBV DNA levels are associated with better underlying histology High HBV DNA may be an independent predictor for cirrhosis and HCC Sustained suppression of HBV may reduce longterm risk of cirrhosis and HCC Hypothesis needs to be proven prospectively,Data Review: Associations of HBV DNA with Outcomes,ii. Impact of treatment,11,Consistent relationship in treated and untreated patients HBV DNA could be used as a marker of effic
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