爱爱医资源-干扰素vs核苷类似物.pptVIP

Cost of Currently Available Therapies for Treatment of Hepatitis B Lamivudine 100 mg/day Cost/day: $6.80 Cost/year: $2482 Adefovir 10 mg/day Cost/day: $18.11 Cost/year: $6647 Entecavir 0.5 mg/day Cost/day: $23.82 Cost/year: $8694 Telbivudine 600 mg/day Cost/day: $16.23 Cost/year: $5924 Peginterferon alfa-2a 180 ug/week Cost/day: $385.00 Cost/year: $18,480 Tenofovir* 300 mg/day Cost/day: $15.92 Cost/year: $5811 HBV DNA Associated With Increased Risk of HCC and Cirrhosis REVEAL: Long-term follow-up of untreated HBsAg positive individuals in Taiwan REVEAL: Persistent HBV DNA Associated With Increased HCC Risk Reversal of Fibrosis With Long-termNucleos(t)ide Analogue Therapy Paired biopsies from before, after 3 years of lamivudine(N = 63) HAI necroinflammatory scores 56% improved by ≥ 2 points 33% had no change 11% had worsening (YMDD mutations blunted the response) Fibrosis 63% (12/19) had improvement in bridging fibrosis by ≥ 1 73% (8/11) had improvement in cirrhosis (score 4 → ≤ 3) Only 2% (1/52) had progression to cirrhosis and 9% (3/34) to bridging fibrosis—all with YMDD mutations PegIFN alfa-2a vs LAM vs Combination at 48 Weeks in HBeAg(+) Patients PegIFN alfa-2a vs LAM vs Combination: Off-Treatment Follow-up IFN vs Nucleos(t)ide Analogues (cont’d) Use of pegIFN in young patients Very small proportion will benefit Most will require longer treatment with nucleos(t)ide analogues PegIFN better in genotype A B C D Favorable genotypes becoming vanishingly rare Predictors of HBeAg response same for pegIFN and nucleos(t)ide analogues * * * * * * /hep Applying the Updated Practice Guidelines to the Management of Hepatitis B Debate: Nucleos(t)ide Analogues vs Peginterferon in Treatment-Naive HBeAg-Positive Patients Peginterferon as First-Line Treatment in HBeAg-Positive Patients Robert P. Perrillo, MD Associate Director, Hepatology Coordinator, Liver Fellowship Program Hepatology Division Baylor University Medical Center Dallas, Texas Magnitude of HB