丙肝治愈丙肝的最佳选择__培训课件.pptx

派罗欣?－治愈中国丙肝患者的最佳选择派罗欣? 180ug/周+安慰剂, 48 周A:普通干扰素3 MIU tiw+RBV1000/1200mg/天,48 周B:根据派罗欣?两项III期临床研究结果确立了标准丙肝治疗方案Fried研究 Hadziyannis 研究 派罗欣? 180ug/周+RBV800mg/天,24 周A:派罗欣? 180 ug/周+RBV 1000/1200mg/天,24周B:派罗欣? 180ug/周+RBV800mg/天,48周C:派罗欣? 180ug/周+ RBV 1000/1200 mg/天, 48 周C:派罗欣? 180ug/周+RBV1000/1200mg/天,48 周D: 75kg患者，利巴韦林1200mg75kg患者，利巴韦林1000mg所有患者治疗结束后随访24周所有患者治疗结束后随访24周Fried MW et al. N Engl J Med. 2002Hadziyannis SJ. Ann Intern Med.美国指南推荐慢性丙肝治疗方案ALT 正常的病人如肝活检有活动性病变应采取治疗，如无炎症反应或病变轻微则应定期随访检查。AASLD guidelineAASLD 指南…… the design of the peginterferon alfa-2a study was the only one capable of determining that a treatment duration of 6 months is sufficient for persons infected with HCV genotypes 2 or 3. Peginterferon α-2a的研究设计是唯一能够确定基因2/3型丙肝患者只需治疗6个月（24周）的研究。Cochrane荟萃分析显示派罗欣?的临床疗效显著较好共有8项临床研究对比派罗欣?方案与PEG-IFN alfa-2b方案的SVR率，包括4335例患者，最终结果显示：派罗欣?的疗效显著更好 (P=0.004) 比值比，95%CI 研究 比值比，95%CI 1.05 [0.62,1.79] Sinha 2004 Yenice 20061.38 [0.79,2.43]Scotto 20081.09 [0.55,2.16]Rumi 20091.22 [1.04,1.42]McHutchison 20091.05 [0.96,1.15]1.26 [1.06,1.51]Ascione 20091.07 [0.85,1.34]Kolakowska 20081.09 [0.79,1.52]Laguno 20091.11 [1.04,1.19]总体结果(95% CI)P=0.00410.52PEG-IFN 2b 派罗欣? Awad T, et al. Hepatology. 2010; 51(4): 1176-84. 派罗欣? + RBVPeg-IFN?-2b (12KD) + RBV63%54%511444200120042006Hadziyannis4Manns1Lee2派罗欣? 临床实践印证III期研究结果所有基因型73%8066%706056%55%50SVR (%=13417383344530200220062006Fried3Zeuzem5Zehnter6 1. Manns M, et al. Lancet 2001; 358: 958. 2. Lee S, et al. Aliment Pharmacol Ther 2006; 23: 397 3. Fried M, et al. N Engl J Med 2002; 347: 975 . 4. Hadziyannis S, et al. Ann Intern Med 2004; 140: 3465. Zeuzem S, et al. J Hepatol 2005; 43: 250. 6. Zehnter E, et al. 56th AASLD 2005; Abstract 1233派罗欣? 临床实践印证III期研究结果－基因1型派罗欣? + RBV80Peg-IFN?-2b (12KD) +RBV7061%60%6052%52%48%46%5042%SVR (%)40302010475n= 348 298 271 95 9038102001200620062002200520062004Hadziyannis4Fried2Zeuzem6Ferenci5Manns1Diago3Zehnter7Manns M, et al