乙肝感染治疗证据.ppt

Evidence-based Treatment forHepatitis B Infection Joseph Sung MD, PhD Center for Emerging Infectious Diseases Department of Medicine and Therapeutics The Chinese University of Hong Kong HBV Infection 2 billion people in the world infected by HBV 350 million chronic carriers 75% are Asian 25-40% of them had cirrhosis or HCC 1.2 million death per year Natural Course of HBV Infection First line therapy Lamivudine is the most commonly used therapy What is the role of interferon and pegylated interferon? Lamivudine for HBeAg+ CHB Lamivudine for HBeAg+ CHB Interferon for HBeAg+ CHB Interferon for HBeAg- CHB Treatment for HBV Infection Interferon-alpha 15-37% Lamivudine 16%, after 9-12m Combining IFN & Lamivudine? Lamivudine plus Interferon-aLamivudine for 8 week before combination with IFN Lamivudine plus Interferon-aLamivudine for 8 week before combination with IFN Current Treatment Guidelines for HBeAg positive CHB Current Treatment Guidelines for HBeAg negative CHB PIFN vs IFN: phase II Study Peginterferon alfa-2aIndividual Responses at End of Follow-up HBeAg Seroconversion at End of Follow-up According to Baseline ALT Level HBeAg Seroconversion at End of Follow-up (Week 72) by Baseline HBV DNA New Antiviral Agents Adefovir Entecavir Clevudine Telbivudine HBeAg+ (48 weeks, ITT) Entecavir vs Lamivudine in HBeAg positive patients ETV-022 trial (BEHoLD Study Group) Multinational, double-blind, phase 3 study 709 HBeAg(+) patients Randomized to entecavir (0.5 mg/day) or lamivudine (100 mg/day) Entecavir vs Lamivudine in HBeAg negative patients ETV-027 trial Multinational, double-blind, phase 3 study 638 HBeAg(-) nucleoside-naive patients Randomized to entecavir (0.5 mg/day) or lamivudine (100 mg/day) Clevudine Use in Chronic HBV ALT normalization in most patients after 12 weeks ALT and virologic response maintained 24 weeks after treatment Clevudine is safe and well tolerated over 12 weeks of therapy Clevudine Use in Chronic H