聚乙二醇干扰素α-2a和利巴韦林联合治疗慢性丙型肝炎临床观察

目的探讨慢性丙型病毒性肝炎应用聚乙二醇干扰素α-2a注射液（派罗欣）抗病毒治疗所出现的副反应及处理对策。方法慢性丙型病毒性肝炎30例病人采用聚乙二醇干扰素α-2a注射液（派罗欣）联合利巴韦林治疗12月,随访12月。结果在治疗12周时有13/15例出现血清ALT正常,血清HCV RNA阴性;早期应答率为86.6%;在治疗结束时有13/15例患者血清ALT正常,血清HCV RNA阴性（〈80copies/ml）;在随访12月时,持续应答率为76.9%,复发率为23.1%;副反应主要为不同程度的WBC下降及低热、肌肉酸痛。结论聚乙二醇干扰素α-2a可引起多种副反应,应针对所出现的副作用采用相应的护理措施及对症处理,使病人减轻不适症状,以提高治疗的依从性。     

聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎的临床分析

目的 探讨聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎的近期与远期疗效.方法 将38例患者随机分为治疗组20例,用聚乙二醇干扰素α-2a 180 μg皮下注射,每周1次,联合口服利巴韦林500 mg,3次/d,疗程共48周.对照组18例,肌肉注射IFN 300万U,3次/周,联合口服利巴韦林500 mg,3次/d,疗程共48周.结果 治疗组治疗后第12、24及48周患者的ALT复常率分别为45.0%、80.0%、95.0%,对照组分别为38.9%、61.0%和66.7%;HCV-RNA在治疗12、24、48周时阴转率治疗组分别为25.0%、70.0%和80.0%,对照组分别为22.2%、50.0%、77.8%;治疗组与对照组组内比较不同时点差异均有统计学意义(P<0.05或P<0.01);组间比较治疗后48周HCV-RNA转阴率差异无统计学意义(P>0.05),ALT复常率比较差异有统计学意义(P<0.05).结论 聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎的近期与远期疗效均较好,在降低转氨酶方面也优于IFN联合利巴韦林,且用药方便,患者依从性好.     

聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎12例

随着医疗体系的完善和人们生活水平的提高,越来越多的人可以得到先进药物水平的治疗.我院从2003年9月至2005年1月用聚乙二醇干扰素α-2a(PEG-IFN-α2a,派罗欣)联合利巴韦林(RBV)治疗12例慢性丙型肝炎.取得了一定的效果,现报告如下.     

聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎六例

全世界约有 1.7亿人感染了丙型肝炎病毒 (HCV) ,相当于世界人口的 3%。我国HCV感染率为 3.2 %。目前对慢性丙型肝炎多应用干扰素α 联合利巴韦林 (RBV)治疗 ,取得了一定的效果 ,但仍有一部分患者对此治疗方案无应答。我院从 2 0 0 3年 7月起用聚乙二醇干扰素α 2a(PEG IFN α2a ,派罗欣 ,罗氏 )联合RBV治疗 6例慢性丙型肝炎 ,现报告如下。资料与方法一、病例选择6例均符合 2 0 0 0年西安会议修订的《病毒性肝炎防治方案》中慢性丙型肝炎的诊断标准[1] 。其中男 4例 ,女 2例 ;年龄 2 2～ 5 4岁 ,平均 34.5岁 ;病程 2～ 7年 ;治疗前所…     

聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎疗效观察

干扰素联合利巴韦林是我国<丙型肝炎防治指南>[1]推荐的治疗丙型肝炎的标准方案.我们对70例慢性丙型肝炎患者的感染途径、发现病情年限和治疗年限进行了调查,并给予聚乙二醇干扰素(PEG-IFN)α-2a联合利巴韦林治疗,现报道如下.     

聚乙二醇干扰素α-2a联合利巴韦林治疗丙型肝炎70例临床观察

慢性丙型病毒性肝炎是引起肝硬化和肝脏肿瘤的主要原因之一,单独使用干扰素疗效欠佳且易复发[1].目前对HCV感染的标准治疗是聚乙二醇干扰素与利巴韦林联合治疗[3],但仅不到40%的患者可达到持续病毒应答(sustainedvirological response,SVR),大部分患者治疗无效或有早期病毒应答(early virological responses,EVR),而且在治疗中或治疗结束后又复发[4].     

聚乙二醇干扰素α-2a联合利巴韦林个体化治疗慢性丙型肝炎的疗效

目的 探讨据聚乙二醇干扰素α-2a联合利巴韦林应答情况指导治疗的个体化策略在基因1型HCV感染慢性丙型肝炎患者中的应用效果. 方法 140例基因1型HCV感染慢性丙型肝炎患者注射聚乙二醇干扰素α-2a 180 μg,每周一次;联合利巴韦林800～1200 mg/d.治疗4周达到快速病毒学应答(RVR)患者(定为A组)随机分为两组,分别接受24周治疗(A1组)、48周治疗(A2组);未达到RVR者在12周达到完全早期病毒学应答(cEVR)的患者(B组)再随机分为两组,分别接受48周治疗(B1组)、72周治疗(B2组); 24周延迟病毒学应答(PVR)的患者接受72周治疗(C1组),24周无PVR的患者终止治疗(C2组).治疗停止后随访24周.用荧光定量PCR法检测不同时间点的HCV RNA水平,比较不同疗程组的疗效.计量资料两组间比较采用t检验,计数资料采用x2检验.结果 治疗24周患者的治疗结束时病毒学应答(ETR)率为100%,持续病毒学应答(SVR)率为65.9%,复发率为34.1%;治疗48周患者的ETR率为95.3%,SVR率为82.8%,复发率为12.5%;治疗72周患者的ETR率为82.1%,SVR率为67.9%,复发率为14.3%.A1组、A2组患者的SVR率分别是65.9%和84.4%,差异有统计学意义(P<0.00).A组中HCV RNA<1×106拷贝/ml的患者接受24周和48周疗程的SVR率分别为72.7%和100%,差异无统计学意义(P>0.05); HCV RNA≥1 × 106拷贝/ml的患者接受24周和48周疗程的SVR率分别是63.6%和85.3%,差异有统计学意义(P<0.05).B1组、B2组患者的SVR率分别是78.9%和73.7%,差异无统计学意义(P>0.05).C1组患者的SVR率是55.6%.在治疗期间均无特殊不良事件发生.结论 RVR、cEVR是慢性丙型肝炎应答指导的预测因子.获得RVR者,治疗48周比24周的SVR率高;但获得RVR且基线HCV RNA<2×106拷贝/ml患者,可缩短疗程,接受24周的治疗.未获得RVR而达到cEVR的患者,延长治疗至72周并未提高SVR率.24周延迟应答者,延长疗程至72周可以提高SVR率.     

聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎疗效的预测

丙型肝炎呈世界性流行,有逐年增加趋势,目前全球感染率均为3%,我国一般人群抗HCV阳性率为3.2%。丙型肝炎病毒感染后50%～85%可发展为慢性丙型肝炎,其中部分病例可发展为肝硬化和肝细胞癌。近年来,聚乙二醇干扰素（PEG IFN）联合利巴韦林已被用于慢性丙型肝炎的景点治疗,其病毒应答、生物化学和组织学的应答显著高于普通干扰素,早期病毒应答率也高于普通干扰素。     

影响聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎疗效因素分析

慢性丙型肝炎患者常出现高胰岛素血症和胰岛素抵抗，影响干扰素抗病毒的疗效。本研究应用聚乙二醇干扰素α-2a联合利巴韦林治疗90例慢性丙型肝炎患者并分析影响抗病毒疗效的因素。     

聚乙二醇干扰素联α-2a联合利巴韦林治疗慢性丙型肝炎合并血友病2例

聚乙二醇干扰素联合利巴韦林是最有效的抗丙型肝炎病毒(hepatitis C virus,HCV)治疗方案.对于合并血友病的慢性丙型肝炎的抗病毒治疗鲜见国内文献报道.本文报道2例丙型肝炎合并血友病患者,经给予HCV治疗疗效满意,现报道如下.     

Pegylated interferon alpha-2b as monotherapy or in combination with ribavirin in chronic hepatitis delta

Therapy of chronic hepatitis delta with standard interferon therapy has met with limited efficacy. This study was designed to examine the efficacy and safety of peginterferon with or without ribavirin. Thirty-eight serum hepatitis B surface antigen- and HDV RNA-positive patients with alanine aminotransferase (ALT) more than 1.5 times the upper normal limit received peginterferon alpha-2b (1.5 microg/kg) alone as monotherapy (n=16) or in combination with ribavirin (n=22), for 48 weeks. Thereafter, all the patients were maintained on peginterferon for 24 weeks and followed for 24 weeks off therapy. The primary end point studied was the virological and biochemical response at the end of follow-up. HDV RNA was determined by single or nested polymerase chain reaction assays. Twenty-seven patients (71%), 11 receiving monotherapy and 16 receiving the combination treatment, completed the follow-up. At the end of treatment, a virological response was observed in 3 of the patients treated with peginterferon (19%) and in 2 of the patients treated with combination therapy (9%), and a biochemical response was observed in 6 (37.5%) and 9 patients (41%), respectively. In nonresponders, ALT diminished from a mean of 174+/-53 to 86+/-41 IU/L. At the end of follow-up, serum HDV RNA was negative in 8 patients (21%), and a biochemical response was detected in 10 patients (26%). Treatment was discontinued in 25% of the patients, and dosing was modified in 58%. In conclusion, a prolonged course of peginterferon alpha-2b resulted in clearance of serum HDV RNA and ALT normalization in a fifth of patients with chronic hepatitis D, while ribavirin had no effect on the viral clearance rate. Overall tolerance of therapy was poor.     

Pegylated interferon alfa and ribavirin for children with chronic hepatitis C

AIM:To study current treatment options for pediatric hepatitis C infection and their associated success rates.METHODS:We retrospectively reviewed charts of thirty children who had been treated with combination therapy of pegylated interferon alfa plus ribavirin for chronic hepatitis C infection.Patients had been treated with ribavirin(15 mg/kg per day) and either pegylated interferon alfa 2a(180 mg/m 2 once weekly) or pegylated interferon alfa 2b(1.5 mg/kg once weekly).Patients’ follow-up included subjective assessment of complaints,physical examination including weight and height,as well as laboratory evaluations for viral load [before treatment,at 12 wk,and 6 mo following treatment completion,as determined by sustained viral response(SVR)],complete blood count,liver enzymes,alkaline phosphatase,bilirubin,renal function tests,and thyroid function tests.For patients not achieving a two log decrease in viral load at treatment week 12,treatment was discontinued and the patient was considered a treatment non-responder.RESULTS:Thirty children aged 3-18 years were included in the study.Twenty patients(11 males,9 females) received pegylated interferon alfa 2b and ten patients(6 males,4 females) received pegylated interferon alfa 2a.Twenty-three patients were infected with genotype 1,six patients were infected with genotype 3,and one patient was infected with genotype 2.Twenty patients(67%) achieved SVR.Treatment success rates were 90% with pegylated interferon alfa 2a vs 55% with pegylated interferon alfa 2b.Although a trend was noted for improved outcomes in the group receiving pegylated interferon alfa 2a,there were no statistically significant outcome differences between the two treatment groups(P = 0.1).Treatment success was 56.5% for patients infected with genotype 1 virus,compared to 100% for patients infected with other genotypes(P = 0.064).There was no difference in treatment response between males and females.A cut-off age of twelve years was used to dichotomize younger vs older participants;however,no diff     

α-2b干扰素联合利巴韦林治疗丙型肝炎疗效分析

目的探讨α-2b干扰素治疗丙型肝炎的近期与远期疗效。方法给予急、慢性丙型肝炎患者α-2b干扰素5M。肌肉注射，开始一个月每日1次，以后隔日1次，12个月为一个疗程；给予丙型肝炎肝硬化患者3Mu肌肉注射，隔日1次，治疗12个月。所有患者均联合应用利巴韦林，每日0．8～1．2g口服。随访2—5年。结果急性丙型肝炎患者在治疗结束时的应答率（ETR）为84．6％，稳定应答率（SR）为76．9％，慢性丙型肝炎ETR为61．4％，SR为52．3％（P〈0．05）；在5例丙型肝炎肝硬化患者，ETR为3例，SR2例；急慢性肝炎患者在治疗的最初1个月内应答者，其复发率低于1个月后才应答者（P〈0．01）。结论α-2b干扰素治疗丙型肝炎的近期与远期疗效均较好，干扰素治疗的安全性较好，代偿期肝硬化患者也可抗病毒治疗。     

Pegylated interferon alfa-2b plus ribavirin for treatment of chronic hepatitis C

AIM: To study the safety and efficacy of pegylated interferon alfa-2b, indigenously developed in India, plus ribavirin in treatment of hepatitis C virus(HCV). METHODS: One-hundred HCV patients were enrolled in an open-label, multicenter trial. Patients were treated with pegylated interferon alfa-2b 1.5 μg/kg per week subcutaneously plus oral ribavirin 800 mg/d for patients with genotypes 2 and 3 for 24 wk. The same dose of peginterferon plus weight-based ribavirin(800 mg/d for ≤ 65 kg; 1000 mg/d for 65-85 kg; 1200 mg/d for 85-105 kg; 1400 mg/d for 105 kg body weight) was administered for 48 wk for patients with genotypes 1 and 4. Serological and biochemical responses of patients were assessed.RESULTS: Eighty-two patients(35 in genotypes 1 and 4 and 47 in 2 and 3), completed the study. In genotype 1, 25.9% of patients achieved rapid virologic response(RVR): while the figures were 74.1% for early virologic response(EVR) and 44.4% for sustained virologic response(SVR). For genotypes 2 and 3, all patients bar one belonged to genotype 3, and of those, 71.4%, 87.5%, and 64.3% achieved RVR, EVR, and SVR, respectively. In genotype 4, 58.8%, 88.2%, and 52.9% of patients achieved RVR, EVR, and SVR, respectively. The majority of patients attained normal levels of alanine aminotransferase by 4-12 wk of therapy. Most patients showed a good tolerance for the treatment, although mild-to-moderate adverse events were exhibited; only two patients discontinued the study medication due to serious adverse events(SAEs). Eleven SAEs were observed in nine patients; however, only four SAEs were related to study medication.CONCLUSION: Peginterferon alfa-2b, which was developed in India, in combination with ribavirin, is a safe and effective drug in the treatment of HCV.     

Cost-effectiveness of combination peginterferon alpha-2a and ribavirin compared with interferon alpha-2b and ribavirin in patients with chronic hepatitis C

BACKGROUND: Sustained virological response (SVR) is the primary objective in the treatment of chronic hepatitis C (CHC). Results from a recent clinical trial of patients with previously untreated CHC demonstrate that the combination of peginterferon alpha-2a and ribavirin produces a greater SVR than interferon alpha-2b and ribavirin combination therapy. However, the cost-effectiveness of peginterferon alpha-2a plus ribavirin in the U.S. setting has not been investigated. METHODS: A Markov model was developed to investigate cost-effectiveness in patients with CHC using genotype to guide treatment duration. SVR and disease progression parameters were derived from the clinical trials and epidemiologic studies. The impact of treatment on life expectancy and costs were projected for a lifetime. Patients who had an SVR were assumed to remain virus-free for the rest of their lives. In genotype 1 patients, the SVRs were 46% for peginterferon alpha-2a plus ribavirin and 36% for interferon alpha-2b plus ribavirin. In genotype 2/3 patients, the SVRs were 76% for peginterferon alpha-2a plus ribavirin and 61% for interferon alpha-2b plus ribavirin. Quality of life and costs were based on estimates from the literature. All costs were based on published U.S. medical care costs and were adjusted to 2003 U.S. dollars. Costs and benefits beyond the first year were discounted at 3%. RESULTS: In genotype 1, peginterferon alpha-2a plus ribavirin increases quality-adjusted life expectancy (QALY) by 0.70 yr compared to interferon alpha-2b plus ribavirin, producing a cost-effectiveness ratio of $2,600 per QALY gained. In genotype 2/3 patients, peginterferon alpha-2a plus ribavirin increases QALY by 1.05 yr in comparison to interferon alpha-2b plus ribavirin. Peginterferon alpha-2a combination therapy in patients with HCV genotype 2 or 3 is dominant (more effective and cost saving) compared to interferon alpha-2b plus ribavirin. Results weighted by genotype prevalence (75% genotype 1; 25% genotype 2 or 3) also show that peginterferon alpha-2a plus ribavirin is dominant. Peginterferon alpha-2a and ribavirin remained cost-effective (below $16,500 per QALY gained) under sensitivity analyses on key clinical and cost parameters. CONCLUSION: Peginterferon alpha-2a in combination with ribavirin with duration of therapy based on genotype, is cost-effective compared with conventional interferon alpha-2b in combination with ribavirin when given to treatment-na?ve adults with CHC.