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在以核酸聚合物为基础的治疗期间,快速单相HBsAg下降预测了功能治愈

Leeor Hershkovich¹, Louis Shekhtman^1,2, Michel Bazinet³

¹Program for Experimental & Theoretical Modeling, Department of Medicine, Division of Hepatology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.

Hepatology communications

|July 17, 2023

概括

慢性乙型肝炎的功能治愈与基于核酸聚合物 (NAP) 的治疗期间,乙型肝炎表面抗原 (HBsAg) 的快速,单相下降有关. 非单相HBsAg模式预测缺乏功能治疗.

科学领域:

肝病学肝病学是一种肝病学.
病毒学病毒学
免疫学免疫学免疫学

背景情况:

慢性乙型肝炎 (CHB) 需要有效的疗法来实现功能治愈,由不可检测的乙型肝炎表面抗原 (HBsAg) 和HBV DNA来定义.
基于核酸聚合物 (NAP) 的疗法为CHB管理提供了潜在的策略,但了解与治愈相关的动态模式至关重要.
血清HBVDNA,HBsAg,抗HBs和ALT的相互作用提供了关于CHB治疗期间治疗反应的见解.

研究的目的:

分析HBsAg,HBV DNA和ALT在HBeAg阴性CHB患者的NAP治疗期间的动态模式.
为了确定与治疗停止后实现功能治愈相关的特定动力学概况.
评估HBsAg动力学对功能治愈的预测价值.

主要方法:

在REP 401研究中,注册了HBeAg阴性CHB患者,这些患者初步接受了tenofovir-disoproxil-fumarate (TDF) 单疗法,随后进行了三重疗法 (TDF + 基化干扰素-α2a + NAP).
参与者被分为早期或延迟的三重疗法组.
治疗后48周评估了功能性愈合;动态模式 (单相与双相下降) 由HBsAg水平的斜率变化来定义.

主要成果:

37名参与者完成了这项研究,35%的人实现了功能治愈.
所有参与者在整个TDF单疗法和组合疗法中都保持了无法检测的HBVDNA.
在所有获得功能治愈的参与者中,在三重治疗期间观察到单相HBsAg下降,与不响应者相比,HBsAg损失的时间显著缩短.

结论:

功能性治疗CHB强烈与基于NAP的三重治疗期间的快速,单相HBsAg下降有关.
一个非单相的HBsAg动态模式显示了功能治愈的100%负预测值.
监测HBsAg动态为预测CHB治疗结果提供了有价值的预后信息.

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