抗乙肝病毒核苷类药物导论.pptVIP

* 治疗12月 两组的HBV DNA下降的绝对值和完全应答率差异是有统计学意义的 但即便是ETV组也有超过一半的患者无明显的HBV DNA的下降 * * ETV病毒学耐药数字 * PCR, polymerase chain reaction. This has led to the concept of a roadmap for managing patients who have a suboptimal response, published by me and my colleagues. We suggested, as have other guidelines, that patients should be assessed at Week?12 for a primary nonresponse, and we define that as less than a 1 log reduction from baseline of serum HBV?DNA. But the most critical time is Week?24 and as shown here on the left in the green, if patients have undetectable HBV?DNA at Week 24, then they have had a complete response. They are off to a good start, you have chosen the right drug, and you can continue therapy with monitoring every 6 months. In the middle in the blue are patients who have had a partial response, where viral load is somewhere between 60 and 2000 IU/mL. Here, the treatment strategy varies a little bit. If the drug being used is a less potent drug that has a lower genetic barrier to resistance, then one might consider adding a second drug. On the other hand, if one is using a drug that has a high genetic barrier to resistance and is more potent, it might be safe and prudent to continue to monitor that patient for another 6 months but at every 3?month intervals. However, if there is an inadequate response at Week?24, where the HBV?DNA is more than 2000?IU/mL, it is time to do something different—typically, adding a more potent drug, although one might consider potentially switching to a more potent drug that is not cross?resistant. * 这张图列举了目前核苷类药物在核苷初治患者中耐药发生的趋势和数据 我可以清楚的看到：拉米夫定的耐药率发生很高，5年治疗近80%的患者产生了耐药 阿德福韦短期治疗虽然不高，但是长期治疗也有近三分之一的患者产生耐药 替比夫定缺乏长期耐药数据，就短期数据而言，2年已有25%患者发生耐药 博路定是目前唯一拥有长达6年耐药监测数据的药物 核苷初治患者长期治疗累计耐药发生率仅为1.2%，也就是治疗100个患者仅有1例发生耐药 远远低于其他在中国上市核苷类药物，有效保障您的长期治疗成功 治治疗失败（Treatment Failure）的三种类型——2012EASL 定义 EASL. J Hepatol (2012), /10.1016/j.jhep.2012.02.010. * 基于路线图的换药时机 Keeffe E, et al. Clin Gastroenterol Hepatol. 2008;6:1315-41. 12周 评估原发性无应答 24周 评估早期疗效预