讲者二 丙肝个体化治疗-20090530.ppt

* * Another way to look at this is to recall one of the basic tenets of HCV RNA therapy: If a patient is not negative for HCV RNA by Week?24, one can confidently discontinue treatment because there is virtually no chance of achieving SVR. However, there are many ways a patient can become negative for HCV RNA before Week?24, and the question is whether all these patients have the same likelihood of achieving SVR. The foregoing discussion suggests that the answer to this is no. To illustrate, this figure shows that a patient who achieves RVR and is treated for a full 48?weeks will have 44?weeks of HCV RNA undetectability. Patients who clear HCV RNA for the first time at Week 12, when treated for 48 weeks, will have undetectable HCV RNA for only 36?weeks. Finally, patients with the slowest virologic response, who clear HCV RNA for the first time by Week 20, will have undetectable HCV RNA for only 28?weeks. * 初治的基因1型丙型肝炎：根据HCV RNA转阴时间制定个体化疗程 教授 医院 初治基因1型丙肝, 标准48周疗程:初次HCV RNA转阴时间预测SVR 初次HCV RNA转阴时间的SVR预测 HCV RNA SVR 2008 AASLD Poster #1868 第4周HCV RNA下降幅度预测SVR 2008 AASLD Poster #1868 SVR% 80 HCV RNA转阴是SVR最佳预测因素 SVR% RVR：第4周HCV RNA阴性 cEVR:第12周HCV RNA阴性 Sulkowski,l. EASL 2009 第4周达到RVR能否缩短疗程至24周? 基因1型、低病毒载量*的疗程 PEG-IFN ?-2b 1.5 μg/kg/周 + 利巴韦林 800 mg/天 n=38 PEG-IFN ?-2b 1.5 μg/kg/周 + 利巴韦林 800-1,400 mg/天n=235 24 周疗程 48 周疗程(历史对照 ) 24 周随访 24 周随访 S Zeuzem et al. J. Hepatol., 2006 Zeuzem S et al, J Hepatology, 2006;44:97-103. (* 基因HCV RNA6?105 IU/mL) Manns et al., Lancet 2001;358:958-65 不同HCV RNA转阴时间的SVR(24周疗程) Zeuzem S et al, J Hepatology, 2006;44:97-103. HCV RNA转阴时间 N=235, 47% 的患者第4周HCV RNA (?) 基因1型低载量，达到RVR者的SVR Zeuzem S et al, J Hepatology, 2006;44:97-103. SVR% 第12周HCV RNA(+), 24周(?)延长疗程至72周： 提高SVR，降低复发率? 标准48周疗程的SVR 2008 AASLD Poster #1850 (328/407) (303/366) (344/466) 缓慢应答者 PEG IFN ?-2b + RBV治疗基因1型缓慢应答者 病人特征: 基因1型, 初治丙肝患者, 48%难治的美国黑人 ALT升高,79%高病毒载量，24%F3/4，30% BMI30 HCV RNA(+) 且 2log ? n=86 PEG-IFN ?-2b 1.5 ?g/kg/周 +按体重 RBV ，治疗 48 周 PEG-IFN ?-2b 1.5 ?g