【优质】HBV最新进展.pptVIP

ADV, adefovir; ETV, entecavir; LAM, lamivudine; LdT, telbivudine; TDF, tenofovir. * * * ADV, adefovir; ETV, entecavir; LAM, lamivudine; LdT, telbivudine; TDF, tenofovir. * * * Schering-Plough PPT Template * * * * * * Schering-Plough PPT Template * * Figures used with permission from Patrick Marcellin, MD. * * * 小结FDA批准的口服HBV治疗 *Approximate and relative. ?Number of mutations needed for primary antiviral drug resistance. ?Only includes reported adverse events that may differ in historical incidence associated with LAM and, therefore, potentially affecting selection vs other agents. Pancreatitis has been reported as a class effect and all agents have to be dose adjusted for renal insufficiency. § From HIV databases Oral Drug Antiviral Potency* Pharmacologic Barrier Genetic Barrier? Adverse Events? LAM + + 1 -- ADV ++ + 1 Nephrotoxicity (≤1% per year) ETV ++++ ++++ 3 -- LdT ++ ++ 1 Myalgia, myositis, neuropathy, cardiac arrhythmia (rare) TDF ++++ ++++ ? Nephrotoxicity§ 初开始治疗最佳核苷类选择 Use nucleos(t)ides as monotherapy with Highest antiviral potency and genetic barrier to resistance Low incidence of resistance over time Rapid and sustained to maximize cumulative benefit LAM/LdT/ADV not generally recommended as first-line therapy Combination therapy may be considered in patients where avoiding resistance is especially important Currently no data supporting this approach vs newer monotherapies Consider individual patient characteristics in relation to safety Comorbidities (ie, compromised renal function) Coinfections (ie, anti-HIV activity of agents) Conception planning Keeffe EB, et al. Clin Gastroenterol Hepatol. 2008;6:1315-1341. EASL HBV Guidelines. J Hepatol. 2009;50:227-242. Lok AS, et al. Hepatology. 2007;45:507-539. 小结：选择干扰素做为初始治疗 选择干扰素的相关因素 适合用药者 基因型 A or B C or D 基线低HBV DNA (baseline and on treatment) 基线高ALT (baseline) 特殊人群 年轻人 将来有生育欲望的年轻女性 病人自己选择 没有HIV合并感染 合并HCV感染 培干扰素治疗相关的副作用 Patients should be carefully monitored for adverse events Most common adve