Successful treatment with peginterferon alfa-2b of HBeAg-positive HBV non-responders to standard interferon or lamivudine

被引:17
作者
Flink, Hajo J.
Hansen, Bettina E.
Heathcote, E. Jenny
Feinman, S. Victor
Simsek, Halis
Karayalcin, Selim
Mach, Tomasz
Leemans, Wim F.
de Man, Robert A.
Verhey, Elke
Schalm, Solko W.
Janssen, Harry L. A.
机构
[1] Univ Med Ctr, Erasmus Med Ctr, Dept Gastroenterol & Hepatol, NL-3015 GD Rotterdam, Netherlands
[2] Univ Med Ctr, Erasmus Med Ctr, Dept Epidemiol & Biostat, NL-3015 GD Rotterdam, Netherlands
[3] Toronto Western Hosp, Univ Hlth Network, Toronto, ON M5T 2S8, Canada
[4] Mt Sinai Hosp, Liver Dis Unit, Toronto, ON M5G 1X5, Canada
[5] Hacettepe Univ, Fac Med, Dept Gastroenterol, TR-06100 Ankara, Turkey
[6] Med Sch Cebeci Kampusu, Dept Gastroenterol, Ankara, Turkey
[7] Jagiellonian Univ, Sch Med, Dept Infect Dis & Hepatol, Krakow, Poland
关键词
D O I
10.1111/j.1572-0241.2006.00812.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
OBJECTIVES: Antiviral therapy leads to HBeAg seroconversion in 10-40% of the patients with HBeAg-positive chronic hepatitis B. Nonresponse may result in progression of liver disease and increased risk of hepatocellular carcinoma. As part of a global randomized controlled trial we investigated the efficacy (i.e., loss of HBeAg at the end of follow-up) of peginterferon alfa-2b (Peg-IFN alpha 2b) in patients who failed to respond to previous courses of standard interferon (IFN) or lamivudine. METHODS: We analyzed a total of 76 previous nonresponders: 37 were nonresponders to standard IFN, 17 were nonresponders to lamivudine, and 22 were nonresponders to both therapies. All patients received a 52-wks course of 100 mu g Peg-IFN alpha 2b weekly combined with either 100 mg lamivudine daily or a placebo. After therapy patients were followed for 26 wks. RESULTS: Thirteen (35%) nonresponders to previous IFN, five (29%) nonresponders to previous lamivudine, and four (22%) nonresponders to both IFN and lamivudine responded to treatment with Peg-IFN alpha 2b. No difference in response was found for those treated with Peg-IFN alpha 2b alone or in combination with lamivudine. Nonresponders to prior IFN therapy with baseline ALT (alanine aminotransferase) > 4 x ULN (upper limit of normal) responded better to Peg-IFN alpha 2b than those with ALT levels <= 4 x ULN (53% vs 20%, respectively, p = 0.036). CONCLUSIONS: Peg-IFN alpha 2b is effective in approximately one-third of patients who failed to respond to previous treatment with standard IFN or lamivudine. High serum ALT level at baseline of Peg-IFN alpha 2b therapy was the best predictor for response in these patients.
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页码:2523 / 2529
页数:7
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