Assessment of treatment responses in patients with chronic active hepatitis B

Yıl 2013, Cilt: 12 Sayı: 2, 58 - 65, 01.08.2013

İbrahim Başarır Sevil İlikhan Ferda Harmandar - Utku Erdem Soyaltın Selim Aydemir - Yücel Üstündağ -

Öz

Background and Aims:In this study, patients with chronic hepatitis B, treated in Bülent Ecevit University School of Medicine, Department of Gastroenterology, were evaluated retrospectively with respect to antiviral efficacy and adverse effects. Materials and Methods:Treatment responses, resistance rates and side effects of 241 patients treated between 2001 and 2010 in the gastroenterology clinic were examined retrospectively. Results:There were no statistically significant differences between 35 naive patients treated with entecavir and 20 naive patients treated with tenofovir regarding demographic characteristics. After a one-year period of treatment, similar antiviral activity was detected between these two groups. Two patients who had lamivudine resistance were switched to tenofovir, and their HBV DNA level became undetectable. For 14 patients with tenofovir treatment, which followed interferon and lamivudine combination treatment, the ratio of undetectable levels of HBV DNA was 81% at the first year and 85% at the second year. Five patients, treated with adefovir after lamivudine treatment and whose HBV DNA levels reached more than 300 copies/ml following one year with adefovir monotherapy, were switched to tenofovir monotherapy. Following 12 and 24 months' treatment, HBV DNA levels became undetectable in all five patients. Conclusions: Entecavir and tenofovir are similar in terms of antiviral activity, side effects and compliance in naive patients. Tenofovir is highly effective in lamivudine-resistant patients and should be the first choice in these patients. Lamivudine resistance does not affect the tenofovir treatment response. Tenofovir monotherapy is highly active in the adefovir- refractory or suboptimal response patients.

Anahtar Kelimeler

Chronic hepatitis B, tenofovir, entecavir

Kronik aktif hepatit B tanılı hastalarımızın tedavi yanıtlarının değerlendirilmesi

Öz

Giriş ve Amaç:Bülent Ecevit Üniversitesi Tıp Fakültesi Gastorenteroloji Kliniğinde tedavi edilen kronik hepatit B olgularımızı retrospektif olarak değerlendirerek uygulanan ajanların; antiviral etkinliklerinin ve ilaç yan etkilerinin araştırılması planlanmıştır. Gereç ve Yöntem:Çalışmamızda 2001-2010 yılları arasında gastroenteroloji kliniğinde tedavi edilen 241 hastanın; tedaviye yanıt ve direnç oranları ile ilaç yan etkileri incelendi. Bulgular: Karakteristik özellikler açısından aralarında fark olmayan; entekavir kullanan 35 ve tenofovir kullanan 20 naiv hastanın, bir yıllık tedavi sonunda antiviral etkinlikleri benzer saptandı. Lamivudin direnci saptanan 2 hastada tenofovir monoterapisiyle HBV DNA saptanabilir düzeyin altına indi. İnterferon ve lamivudin ikili tedavi sonrası tenofovir monoterapisine geçilen 14 hastada HBV DNA'nın saptanabilir düzeyin altına inmesi oranı sırasıyla ilk yılda %81, 2. yılda %85'ti. Lamivudin sonrası, adefovir tedavisine geçilen ancak HBV DNA düzeyi 1 yıllık tedavi ile 300 kopya/ml'nin üzerinde olan 5 hastada tenofovir monoterapisine geçildi. 12 ve 24 aylık tedavi sonunda bu hastaların tamamında HBV DNA saptanabilir düzeyin altına indi. Sonuç:Entekavir ve tenofovir; naiv hastalarda antiviral etkinlik, yan etki ve komplians bakımından benzer özelliktedir. Tenofovir, lamivudin dirençli hastalarda yüksek etkinlikte olup ilk seçenek ilaçtır. Lamivudine direnç varlığı tenofovir cevabını etkilememektedir. Tenofovir monoterapisi; adefovire yanıtsız, suboptimal yanıtlı hastalarda dahi yüksek etkinliktedir

Anahtar Kelimeler

Kronik hepatit B, tenofovir, entekavir

Kaynakça

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