系列分享 | 最全证据!临床治愈可显著改善慢乙肝远期结局

2020
08/06

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雨露肝霖
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编者按:临床治愈的相关研究已进入深入探索阶段,最近慢乙肝临床治愈珠峰工程项目年度工作会议上也传来喜报,从2018年珠峰项目启动以来,已有超1400例患者实现临床治愈,是非常值得期待的。临床治愈的持久性和复发因素以及临床治愈与远期预后的关系一直是专家和患者都关注的重点问题。肝霖君曾系统分析临床治愈后慢乙肝患者持久性佳和可显著改善远期结局的相关内容,这期系列分享将和大家整合最新证据,并进行系统回顾。

为了更系统地了解慢乙肝临床治愈这十余年来的进展情况,雨露肝霖将推出4篇临床治愈系列文章,上期第3篇与大家分享了十年慢乙肝临床治愈详细研究结果,今天最后1篇将为大家带来临床治愈可显著改善慢乙肝远期结局的最全证据。

01

慢乙肝患者获得临床治愈后持久应答率高

现有国内外指南均认可临床治愈作为慢乙肝抗病毒治疗的理想结局。现有基于PEG IFNα的治疗策略已可大大提升慢乙肝患者临床治愈率,因此临床治愈后的持久性和能否安全停药也成为了大家重点关注的问题。

最近慢乙肝临床治愈峰会暨中国派高峰论坛第二场会议上,众多专家也探讨了这个问题,均认可慢乙肝临床治愈后持久性佳,复发率低,复发率均< 10%。从下表的多项研究均可证实不论通过何种方式获得临床治愈,其持久性佳,基本维持在85%以上。

然而,我们知道NA单药治疗的HBsAg清除率极低,仅为 1-3%。因此,慢乙肝患者若想追求高临床治愈率和持久应答率,应选择基于PEG IFNα的治疗方式。

02

临床治愈可显著改善慢乙肝患者远期结局

我国原发性肝癌中92%是HBV感染导致,而慢乙肝患者的最终治疗目标是改善远期结局,如肝癌发生发展的风险,从而提高生存率和生活质量。肝霖君曾系统分析慢乙肝患者获得HBsAg清除后肝癌发生风险显著降低的相关研究。

为方便大家查看,我们汇总最新证据,多项来自美国、加拿大、日本和中国的针对不同国家和地区人群的回顾性研究和荟萃研究显示,慢乙肝患者获得临床治愈后5年累积肝癌发生率为1.5%左右,甚至更低,显著低于未获得临床治愈的人群(> 5%)。这证实了慢乙肝患者获得临床治愈后可显著改善远期结局。

参考文献:(可上下滑动查看)

[1] Wu Y, Liu Y, Lu J, et al. Durability of Interferon-induced Hepatitis B Surface Antigen Seroclearance[J]. Clin Gastroenterol Hepatol, 2020, 18(2): 514-516 e512.

[2] Yip TC, Wong GL, Wong VW, et al. Durability of hepatitis B surface antigen seroclearance in untreated and nucleos(t)ide analogue-treated patients[J]. J Hepatol, 2017.

[3] Chi H, Wong D, Peng J, et al. Durability of Response After Hepatitis B Surface Antigen Seroclearance During Nucleos(t)ide Analogue Treatment in a Multiethnic Cohort of Chronic Hepatitis B Patients: Results After Treatment Cessation[J]. Clin Infect Dis, 2017, 65(4): 680-683.

[4] Li MH, Yi W, Zhang L, et al. Predictors of sustained functional cure in hepatitis B envelope antigen-negative patients achieving hepatitis B surface antigen seroclearance with interferon-alpha-based therapy[J]. J Viral Hepat, 2019, 26 Suppl 1: 32-41.

[5] Liu Y, Li H, Yan X, et al. Long-term efficacy and safety of peginterferon in the treatment of children with HBeAg-positive chronic hepatitis B[J]. J Viral Hepat, 2019, 26 Suppl 1: 69-76.

[6] Alawad AS, Auh S, Suarez D, et al. Durability of Spontaneous and Treatment-Related Loss of Hepatitis B s Antigen[J]. Clin Gastroenterol Hepatol, 2020, 18(3): 700-709 e703.

[7] Lok AS, Zoulim F, Dusheiko G, et al. Durability of Hepatitis B Surface Antigen Loss With Nucleotide Analogue and Peginterferon Therapy in Patients With Chronic Hepatitis B[J]. Hepatol Commun, 2020, 4(1): 8-20.

[8] Han M, Jiang J, Hou J, et al. Sustained immune control in HBeAg-positive patients who switched from entecavir therapy to pegylated interferon-alpha2a: 1 year follow-up of the OSST study[J]. Antivir Ther, 2016, 21(4): 337-344.

[9] Yip TC, Chan HL, Wong VW, et al. Impact of age and gender on risk of hepatocellular carcinoma after hepatitis B surface antigen seroclearance[J]. J Hepatol. 2017 Nov;67(5):902-908.

[10] Tateda K, Suzuki F,  Kobayashi M, et al. Predictive Factors Associated with Hepatocellular Carcinoma Incidence and Mortality after Hepatitis B Surface Antigen Seroclearance in Patients with Chronic Hepatitis B. AASLD2018 abstract (oral 213).

[11] Yip TC, Wong GL, Chan HL, et al. HBsAg seroclearance further reduces hepatocellular carcinoma risk after complete viral suppression with nucleos(t)ide analogues[J]. J Hepatol, 2019, 70(3): 361-370.

[12] Song C, Zhu J, Ge Z, et al. Spontaneous Seroclearance of Hepatitis B Surface Antigen and Risk of Hepatocellular Carcinoma[J]. Clin Gastroenterol Hepatol, 2019, 17(6): 1204-1206.

[13] F. Liu, X.-W. Wang, L. Chen, et al. Systematic review with meta-analysis: development of hepatocellular carcinoma in chronic hepatitis B patients with hepatitis B surface antigen seroclearance[J]. Aliment Pharmacol Ther. 2016 Jun;43(12):1253-61.

[14] Kuang XJ, Jia RR, Huo RR, et al. Systematic review of risk factors of hepatocellular carcinoma after hepatitis B surface antigen seroclearance[J]. J Viral Hepat, 2018, 25(9): 1026-1037.

[15] Jiang JF, Sun J, Shi J, et al. Letter: hepatocellular carcinoma risk after hepatitis B surface antigen seroclearance[J]. Aliment Pharmacol Ther. 2017 May;45(9):1286-1288.

[16] Hannah S Choi, Ryan Anderson, Oliver Lenz, et al. Association between HBsAg loss and risk of hepatocellular carcinoma in chronic hepatitis B: a systematic review and Meta-analysis. AASLD2019. Abstracts (poster 671).

[17] Anderson RT, et al. Association Between Seroclearance of Hepatitis B Surface Antigen and Long-term Clinical Outcomes of Patients With Chronic HBV Infection: Systematic Review and Meta-analysis[J]. Clin Gastroenterol Hepatol, 2020.

本文由作者自行上传,并且作者对本文图文涉及知识产权负全部责任。如有侵权请及时联系(邮箱:guikequan@hmkx.cn
关键词:
乙肝,治愈,临床

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