慢性乙肝治疗初始治疗方案地选择.ppt

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慢性乙肝治疗初始治疗方案地选择.ppt

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1957Interferon discovered 1991Interferon alfa-2b approved for HBV 1998Lamivudine (3TC) approved as first nucleoside analogue for HBV 1991 3TC anti-HBV and anti-HIV activity discovered 1990 PMEA anti-HBV activity discovered 2002Adefovir dipivoxil (PMEA prodrug) approved for HBV 1998 Entecavir anti-HBV activity discovered 2005Entecavir and peginterferon alfa-2a approved for HBV 2006Telbivudine approved for HBV 2001 Telbivudine anti-HBV activity discovered HBV Treatment in the United States: 2007 Treatment of Chronic Hepatitis B:Efficacy of Current Regimens HBeAg-Positive Patients Drug Duration of Treatment HBeAg Seroconversion at Yr 1, % HBV DNA Negative at Yr 1,* % Off-Treatment Durability of HBeAg Seroconversion,? % Interferon 4-6 mos ~ 18 37 80-90 Lamivudine ≥ 1 yr 17 40-44 50-80 Adefovir ≥ 1 yr 12 21 91 Entecavir ≥ 1 yr 21 67 76 Peginterferon alfa-2a 1 yr 27 25 NA Telbivudine ≥ 1 yr 23 60 ? 80 *Interferon and lamivudine: hybridization assay; adefovir, entecavir, and peginterferon: PCR assay. ?24 weeks posttreatment. Dienstag JL, et al. N Engl J Med. 1999;341:1256-1263. Wong DK, et al. Ann Intern Med. 1993;119:312-323. Marcellin P, et al. N Engl J Med. 2004;351:1206-1217. Lau GK, et al. N Engl J Med. 2005;352:2682-2695. Baraclude (entecavir) [package insert]. Bristol-Myers Squibb; 2005. Tyzeka (telbivudine) [package insert]. Idenix/Novartis; 2006. Lai CL, et al. AASLD 2006. Abstract 91. Treatment of Chronic Hepatitis B:Efficacy of Current Regimens (cont’d) HBeAg-Negative Patients Drug Duration of Treatment HBV DNA Negative at Yr 1,* % Off-Treatment Durability of HBV DNA Negativity,*? % Interferon 1 yr 60-70 10-20 Lamivudine Indefinite 60-70 10 Adefovir Indefinite 51 ? 5 Entecavir Indefinite 90 NA Peginterferon alfa-2a 1 yr 63 19 Telbivudine Indefinite 88 NA *Interferon and lamivudine: hybridization assay; adefovir, entecavir, and peginterferon: PCR assay. ?24 weeks posttreatment. Hadziyannis S, et al. J Hepatol 1990;11(Suppl 1):S133-S136