在慢性乙型肝炎中使用或不使用免疫调节剂的Xalnesiran
Jinlin Hou1, Wenhong Zhang1, Qing Xie1
1From the Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University (J.H., X.L.), and the State Key Laboratory of Organ Failure Research, Key Laboratory of Infectious Diseases Research in South China, Ministry of Education, Guangdong Institute of Hepatology, Nanfang Hospital (J.H.), Guangzhou, the Department of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University (W.Z.), the Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Q.X.), Roche Holding (Q.B., E.C.), Roche Research and Development Center (C.C., Y.H.), and Takeda APAC Biopharmaceutical Research and Development (Q.B.), Shanghai, the Department of Hepatology, Center of Infectious Diseases and Pathogen Biology, First Hospital of Jilin University, Changchun (R.H.), the Center of Infectious Diseases, Laboratory of Infectious and Liver Disease, Institute of Infectious Diseases, West China Hospital, Sichuan University, Chengdu (H.T.), and the Department of Medicine and State Key Laboratory of Liver Research, Queen Mary Hospital, University of Hong Kong, Hong Kong (M.-F.Y.) - all in China; the Division of Infectious Diseases, University Hospital Álvaro Cunqueiro, Galicia Sur Health Research Institute, Servizo Galego de Saúde-Universidade de Vigo, Vigo, Spain (L.E.M.A.); the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital (S.-S.Y.), and the Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University (C.-Y.P.), Taichung, the Department of Internal Medicine, Changhua Christian Hospital, Changhua (W.-W.S.), Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung (W.-L.C.), and National Taiwan University Hospital, Taipei (J.-H.K.) - all in Taiwan; the Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea (D.J.K.); the HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Center and the Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok (A.A.), and the Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai (A.L.) - both in Thailand; Université de Paris-Cité, Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Centre de Recherche sur l'Inflammation, INSERM Unité Mixte de Recherche 1149, Paris (T.A.); F. Hoffmann-La Roche, Basel, Switzerland (F. Canducci, M.T.C., F. Chughlay, K.G., N.G., P.K., R.K., M.T.); Roche Products, Welwyn Garden City (S.D., V.P., B.S., R.U., C.W.), and ID Pharma Consultancy, Yelverton (C.W.) - both in the United Kingdom; Enthera Pharmaceuticals, Milan (F. Canducci); Parexel International, Hyderabad, India (A.P.); and the New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand (E.G.).
试验性RNA疗法Xalnesiran在与免疫调节剂相结合时,在患有慢性乙型肝炎 (HBV) 感染的患者中,在实现乙型肝炎表面抗原 (HBsAg) 损失方面表现有前途. 然而,观察到一些显著的不良事件,需要仔细考虑.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 病毒学 病毒学
- 在RNA治疗方面,RNA疗法.
背景情况:
- 慢性乙型肝炎病毒 (HBV) 感染仍然是一个全球性的健康挑战.
- 沙尔内西兰是一种小干扰RNA (siRNA),旨在准和沉默多个HBV转录.
- 评估xalnesiran,单独或与免疫调节剂一起,用于慢性HBV治疗至关重要.
研究的目的:
- 为了评估阿克尔内西兰在实现乙型肝炎表面抗原 (HBsAg) 损失的有效性,在病毒学上抑制的慢性HBV患者.
- 为了比较不同剂量的瓦尔内西兰及其与鲁佐托利莫德或基化干扰素α-2a的组合,与核酸/核酸相似物 (NA) 相比.
- 评估基于瓦尔内西兰的疗程的安全性.
主要方法:
- 一个第二阶段,多中心,随机,受控,自适应,开放标签平台试验.
- 159名患有慢性HBV且接受NA治疗的参与者被随机分为五组.
- 治疗包括使用不同剂量的瓦尔内西兰,瓦尔内西兰与鲁佐托利莫德,瓦尔内西兰与基化干扰素α-2a,或单独使用NA,持续48周.
主要成果:
- 在治疗后24周的HBsAg损失发生在7% (100mg的瓦尔内西兰),3% (200mg的瓦尔内西兰),12% (瓦尔内西兰+鲁佐托利莫德) 和23% (瓦尔内西兰+干扰素) 的患者中.
- 在接受瓦尔内西兰加上干扰素的20%的参与者中观察到HBsAg血清转化.
- 3级或4级不良事件在瓦尔内西兰加上干扰素组中最常见 (50%),主要是ALT水平升高.
结论:
- 沙尔内西兰与免疫调节剂,特别是基化干扰素α-2a结合使用,在慢性HBV患者中显示出实现HBsAg损失的潜力.
- 组合疗法显示HBsAg损失和血清转化率较高,与单独使用瓦尔内西兰或单独使用NA相比.
- 显著不良事件的发生,特别是干扰素组合,需要仔细监测安全性.
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