Agustos 2013
Kronik aktif hepatit B tanili hastalarimizin tedavi yanitlarinin degerlendirilmesi
Assessment of treatment responses in patients with chronic active hepatitis B
- Ana Sayfa
- Sayılar
- Agustos 2013
- Kronik aktif hepatit B tanili hastalarimizin tedavi yanitlarinin degerlendirilmesi...
Özet
Giris ve Amaç:Bülent Ecevit Üniversitesi Tip Fakültesi Gastorenteroloji Kliniginde tedavi edilen kronik hepatit B olgularimizi retrospektif olarak degerlendirerek uygulanan ajanlarin; antiviral etkinliklerinin ve ilaç yan etkilerinin arastirilmasi planlanmistir. Gereç ve Yöntem:Çalismamizda 2001-2010 yillari arasinda gastroenteroloji kliniginde tedavi edilen 241 hastanin; tedaviye yanit ve direnç oranlari ile ilaç yan etkileri incelendi. Bulgular: Karakteristik özellikler açisindan aralarinda fark olmayan; entekavir kullanan 35 ve tenofovir kullanan 20 naiv hastanin, bir yillik tedavi sonunda antiviral etkinlikleri benzer saptandi. Lamivudin direnci saptanan 2 hastada tenofovir monoterapisiyle HBV DNA saptanabilir düzeyin altina indi. Interferon ve lamivudin ikili tedavi sonrasi tenofovir monoterapisine geçilen 14 hastada HBV DNA’nin saptanabilir düzeyin altina inmesi orani sirasiyla ilk yilda %81, 2. yilda %85’ti. Lamivudin sonrasi, adefovir tedavisine geçilen ancak HBV DNA düzeyi 1 yillik tedavi ile 300 kopya/ml’nin üzerinde olan 5 hastada tenofovir monoterapisine geçildi. 12 ve 24 aylik tedavi sonunda bu hastalarin tamaminda HBV DNA saptanabilir düzeyin altina indi. Sonuç:Entekavir ve tenofovir; naiv hastalarda antiviral etkinlik, yan etki ve komplians bakimindan benzer özelliktedir. Tenofovir, lamivudin dirençli hastalarda yüksek etkinlikte olup ilk seçenek ilaçtir. Lamivudine direnç varligi tenofovir cevabini etkilememektedir. Tenofovir monoterapisi; adefovire yanitsiz, suboptimal yanitli hastalarda dahi yüksek etkinliktedir
Abstract
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.
