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BMC Infect Dis:DAA治疗基因3型丙型肝炎的整体疗效

2017-11-23 佚名 国际肝病

直接抗病毒药物(DAA)的出现改变了丙型肝炎的治疗格局,随之也出现了一些新的挑战。

直接抗病毒药物(DAA)的出现改变了丙型肝炎的治疗格局,随之也出现了一些新的挑战。例如,干扰素时代治疗起来并不算困难的基因3型患者,在DAA时代似乎成了较为难治的一型,其疾病进展相对较快、肝脏损伤和肝癌风险相对较高,并且其中一些亚亚型患者对当前DAA方案的应答并不好。那么当前基因3型丙型肝炎接受DAA方案治疗的整体情况如何呢?英国学者对此进行了研究。

研究者检索了近5年来(2011年2月至2016年5月)在PubMed、Medline和Embase公开区发表的相关临床试验资料和观察性研究(真实世界)资料,并纳入了5个非索引文献来源(AASLD年会、APASL年会、CROI年会、EASL年会和WHO)1年内(2015年4月至2016年5月)的相关资料作为补充,对这些文献进行系统回顾和描述性统计学分析。

结果显示,在所有全口服方案的临床试验资料中,基于索磷布韦+达拉他韦以及基于维帕他韦的方案的疗效(SVR12)≥90%,这为指南对这几种方案的推荐提供了支持。

另外,grazoprevir+elbasvir+索磷布韦方案和奥比他韦+帕利瑞韦/利巴韦林+索磷布韦方案也很有应用价值。含有新型DAA的全口服、无利巴韦林方案,如pibrentasvir+glecaprevir或grazoprevir+ruzasvir+MK-3682(uprifosbuvir),临床试验报告的SVR12均高于95%。

观察性研究报告的SVR率总体上略低,但反映出与临床试验的一致性,治疗多能取得良好应答。

作者根据SVR12的数据得出几个结论:在治疗基因3型丙型肝炎时,①新药优于老药(含有新型DAA的方案优于含有原有DAA的方案);②新DAA时代不再需要利巴韦林(新型DAA方案加用利巴韦林并不提高疗效)。这说明随着DAA家族的不断壮大,基于干扰素的方案治疗基因3型丙型肝炎的光荣使命可以告一段落了。

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    2017-11-25 一叶知秋
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    2017-11-23 1dd8c52fm63(暂无匿称)

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