核苷类药物抗乙肝病毒的合理用药解析.ppt

ADV, adefovir; ETV, entecavir; IFN, interferon; LAM, lamivudine; LdT, telbivudine; PegIFN alfa-2a, peginterferon alfa 2a. TDF, tenofovir disoproxil fumarate. There are currently 7 US Food and Drug Application (FDA)–approved medications available for the treatment of chronic hepatitis B. Interferon?alfa, approved in the early 1990s, is given either daily or every other day. In 1998, lamivudine was approved, marking the beginning of the new era of oral therapy. The timeline continues with the approval in 2002 of adefovir, followed by both entecavir and peginterferon alfa 2a in 2005. In 2006, telbivudine was approved for treatment of hepatitis?B by the FDA. Tenofovir was approved in August 2008, and there are other medications currently being tested, such as clevudine which is in phase?III trials. Other clinical trials are testing the efficacy of combining more than 1 medication for the treatment of hepatitis?B patients. * * * ADV的优化策略 LAM/LdT优化策略 耐药及应答不佳处理 维持疗效时转换治疗 方案优化 ADV的优化策略 LAM/LdT优化策略 耐药及应答不佳处理 维持疗效时转换治疗 方案优化 Gallego A, Sheldon J, Garcia-Samaniego J, et al. Evaluation of initial virological response to adefovir and development of adefovir-resistant mutations in patients with chronic hepatitis B[J]. J Viral Hepat, 2008, 15(5):392-398. ADV治疗：病毒疗效的早期预测？ 应用ADV治疗的早期预测 用阿德福韦酯治疗的患者 在24周时获得HBVDNA检测不到(12 IU/ml) 的患者，在１年时77%的患者可获得HBV DNA下降≥4 log10 IU/ml， 如果在24周时没有获得HBV DNA检测不到的患者，只有5%的患者HBV DNA下降≥4 log10 IU/ml。 研究结果：病毒疗效的早期预测 Locarnini S,Qi x,Arterburm S, et al. Incidence and p redictors of e2mergence of adforir resistant HBV during 4 years of adeforir dip ivoxil(ADV ) therapy for patients with chronic hepatitis B ( CHB )( abstr) [ J ]. J Hepatol, 2005, 42 ( supp lz) ∶17. ADV治疗:耐药的早期预测？ 应用ADV治疗的早期预测 Locarnini S,Qi x,Arterburm S, et al. Incidence and p redictors of e2mergence of adforir resistant HBV during 4 years of adeforir dip ivoxil(ADV ) therapy for patients with chronic hepatitis B ( CHB )( abstr) [ J ]. J Hepatol, 2005, 42 ( supp lz) ∶17. 研究内容：A