在C型肝炎患者初始DAA失败后,对直接作用药物 (DAA) 进行重新治疗
Nobuharu Tamaki1, Masayuki Kurosaki1, Hironori Ochi2
1Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
概括
对慢性型肝炎的直接作用抗病毒再治疗是非常有效的. 像索福斯布维尔/韦尔帕塔斯维尔加上里巴维林或格莱卡普雷维尔/皮布伦塔斯维尔这样的疗法在初始治疗失败后实现了高持续性病毒学反应率.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 病毒学 病毒学
- 药理学 药理学是指药理学的学科.
背景情况:
- 直接作用的抗病毒 (DAA) 方案,如glecaprevir/pibrentasvir (GLE/PIB) 和sofosbuvir/ledipasvir (SOF/LDV) 是慢性型肝炎的标准第一线治疗方法.
- 虽然高效,但有一部分患者经历治疗失败,需要研究最佳的再治疗策略.
研究的目的:
- 评估各种重复治疗方案的疗效,在慢性型肝炎的初始直接作用抗病毒疗法失败的患者中.
- 为了比较GLE/PIB或SOF/LDV失败后不同再治疗选择的持续病毒学反应率.
主要方法:
- 一项全国性的多中心前性研究招募了330名先前DAA治疗失败的患者 (117名GLE/PIB失败,213名SOF/LDV失败).
- 患者接受了12周的GLE/PIB,索福斯布维尔/韦尔帕塔斯维尔 (SOF/VEL) 加上利巴维林 (RBV) 或SOF/LDV的重新治疗.
- 主要终点是在重新治疗12周后持续的病毒学反应 (SVR12).
主要成果:
- 对于以前有GLE/PIB衰竭的患者,SVR12的发病率为99.0% (SOF/VEL+RBV),92.3% (GLE/PIB) 和100% (SOF/LDV).
- 对于以前有SOF/LDV失败的患者,SVR12的发病率为100% (SOF/VEL+RBV),99.5% (GLE/PIB) 和66.7% (SOF/LDV).
- 用SOF/VEL + RBV或GLE/PIB重复治疗显示,在以前有SOF/LDV失败的患者中,疗效高.
结论:
- 包括SOF/VEL + RBV,12周GLE/PIB或SOF/LDV在内的再处理方案可以达到高的SVR12率.
- 通过可用的直接作用抗病毒疗法,即使在初始治疗失败后,也可以实现有效的病毒根除.
- 具体的再治疗策略表明,在以前DAA失败的患者中,成功率很高.
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