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Peginterferon α in the treatment of chronic hepatitis B

机译:聚乙二醇干扰素α治疗慢性乙型肝炎

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Introduction: Hepatitis B virus (HBV) infection is a global health problem. Peginterferon α (PEG-IFN), which includes PEG-IFN α-2a (Pegasys) and PEG-IFN α-2b (Peg-Intron), can be used to treat patients with chronic hepatitis B (CHB) infection. A finite duration of PEG-IFN therapy may lead to long-term viral suppression. Clinically, it is important to identify super-responders and null-responders to PEG-IFN due to its substantial side effects. Areas covered: From the literature review, it is known that PEG-IFN is more effective for hepatitis B e antigen (HBeAg)-positive patients who have high pre-treatment alanine aminotransferase level, lower HBV DNA level and genotype A (vs genotype D), as well as those with more favourable viral predictors, such as precore stop codon or basal core promoter mutants infections in Asian patients and wild-type virus in Caucasian patients. For HBeAg-positive patients and HBeAg-negative patients with genotype D infection, PEG-IFN therapy could be terminated early at week 12 or 24 in primary non-responders defined by the Hepatitis B surface antigen stopping rules. With regard to host factors, single nucleotide polymorphisms of IL28B do not seem to affect the treatment outcomes in Asian patients, but its role in Caucasian patients remains disputed. Expert opinion: Most of the known predictors need validation by large prospective trials. In addition, we need to identify more baseline predictors for super-responders in order to achieve personalised PEG-IFN treatment for CHB.
机译:简介:乙肝病毒(HBV)感染是全球性的健康问题。 PEG干扰素α(PEG-IFN),包括PEG-IFNα-2a(Pegasys)和PEG-IFNα-2b(Peg-Intron),可用于治疗慢性乙型肝炎(CHB)感染的患者。有限时间的PEG-IFN治疗可能会导致长期的病毒抑制。在临床上,重要的是要确定对PEG-IFN的超级反应者和无效反应者,因为其副作用很大。覆盖范围:从文献综述中可以看出,PEG-IFN对丙型肝炎e抗原(HBeAg)阳性的患者具有更高的疗效,这些患者的治疗前丙氨酸转氨酶水平较高,HBV DNA水平较低且基因型为A(相对于基因型D) ),以及具有更有利的病毒预测因子的病毒,例如亚洲患者的前核心终止密码子或基础核心启动子突变体感染,白种人患者则感染野生型病毒。对于具有D型基因感染的HBeAg阳性患者和HBeAg阴性患者,可以在第12周或第24周早期终止由乙肝表面抗原停止规则定义的主要无反应者中的PEG-IFN治疗。关于宿主因素,IL28B的单核苷酸多态性似乎并未影响亚洲患者的治疗结果,但其在白种人患者中的作用仍存在争议。专家意见:大多数已知的预测变量都需要通过大型前瞻性试验进行验证。此外,我们需要为超级反应者确定更多的基线预测指标,以实现CHB的个性化PEG-IFN治疗。

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