Hepatitis B Therapy

سال انتشار: 1397
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 409

نسخه کامل این مقاله ارائه نشده است و در دسترس نمی باشد

این مقاله در بخشهای موضوعی زیر دسته بندی شده است:

استخراج به نرم افزارهای پژوهشی:

لینک ثابت به این مقاله:

شناسه ملی سند علمی:

MHC05_004

تاریخ نمایه سازی: 30 دی 1397

چکیده مقاله:

Chronic hepatitis B (CHB) is a major global health problem and account for one of the leading causes of morbidity and mortality worldwide. In recent years, development of many effective antiviral agents such as nucleot(s) ide analogues (NAs) has led to improve the clinical outcome in patients with CHB. Studies have demonstrated that NAs are well-tolerated oral drugs with excellent safety profile. However, low rate of HBsAg seroclearance and high risk of virological relapse after discontinuation and high risk of resistant are three important factors that indicate the necessity of long-term or perhaps indefinite NAs therapy in patients. The Main end points to assess the efficacy of NAs therapy are sustained suppression of the HBV DNA levels, normalization of ALT levels, and amelioration in liver histology, and hepatitis B e antigen (HBeAg) seroconversion in HBeAg-positive chronic hepatitis B (CHB) patients. On the other hand, seroclearance of HBsAg is the ideal therapeutic end point in HBeAg-negative patients. This end point introduces as a gold standard of successful treatment but unfortunately it is rare and occurs annually only in <1% of the NAs-treated patients. Although current international guidelines including EASL, AASLD and AASLD represent information regarding when to begin the antiviral therapy with NAs, there is no clear consensus on optimal duration and the proper cessation time of NAs treatment in CHB patients. NA therapy can be stopped in HBeAg-positive individuals if patients achieved HBeAg seroclearance and HBV DNA remains undetectable using a sensitive PCR assay for at least 6 months (AASLD) or12 months (EASL, APASL) . However, cessation of long-term NAs therapy in HBeAg-negative patients is a controversial topic. Both AASLD and EASL guidelines suggest long-term/indefinite or even lifelong treatment in HBeAg-negative individuals until HBsAg clearance. Undoubtedly, this is an unrealistic aim due to several problems such as unaffordable cost and safety issues following with therapy over 10 years. On the contrary, APASL guidelines recommend that HBeAg-negative patients could discontinue NAs after at least 2 years of treatment if they achieved undetectable HBV DNA on three separate occasions 6 months apart. Taken together, evaluation of 1- year off-therapy outcomes such as virological and clinical relapse as well as re-treatment rates in CHB patients have indicated that discontinuation of treatment in HBeAg-positive patients (who had achieved seroconversion to anti-HBe and adequate consolidation therapy before cessation NAs treatment) is acceptable for all major liver associations. In addition, studies have shown that stopping of NAs therapy in HBeAg-negative patients is feasible using proper strategies for follow-up monitoring and re-commencement of the treatment. Moreover, NAs cessation in these individuals with appropriate off-therapy monitoring plan is much safer than discontinuation therapy by patients themselves for financial or willingness reasons and hence lost to follow-

نویسندگان

Seyed-Moayed Alavian

Professor of Hepatology, Baqiyatallah Research Center for Gastroenterology and Liver Disease, Tehran, Iran