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HBV DNA??

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Title: HBV DNA??

1
??????(?)?????????????????????????????2007.6
2
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??? HBV DNA??
????? ?ALT???
???? ??????

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Keeffe EB , el at., A Treatment Algorithm for the
Management of Chronic Hepatitis B Virus Infection
in the United States An Update, 16 July
2006Clinical Gastroenterology and
Hepatology2006 4936962
3
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4
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5
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6
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7
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8
??????????????????????? 1.??(??)???? 2.?????? 3
.??????(????)???
9
???????????,????,???????????
????,????????????????????????,????????????????
10
??????????????? ????????? ?????????
????? ??????? ?????
11
???????
12
??ETV?ADV?????????
10
10
ADV
9
9
Difference at Day 10 (95 CI) -0.655 (-1.30,
-0.01)
ETV
8
8
7
7
HBV DNA (log10 copies/mL)
6
6
5
5
Significant difference between ETV and ADV as
early as Day 10.
4
4
3
3
0
20
40
60
80
????
Leung N, et al. Hepatology 2006 44(Suppl 1)554A
(Abstract 982).
13
????????????????
Collation of currently available data not
from head-to-head studies
Lai CL, et al. Hepatology 2005 42(Suppl 1)748A
(Abstract LB01) Lau G, et al. N Engl J Med 2005
35228822695 Chang T-T, et al. N Engl J Med
2006 35410001010 Lai CL, et al. N Engl J Med
2006 35410111020 Marcellin P, et al. N Engl J
Med 2003 348808816 Marcellin P, et al. N Engl
J Med 2004 34812061217 Hadziyannis SJ, et al.
N Engl J Med 2003 348800807.
14
???????????????
Collation of currently available data not
from head-to-head studies
HBeAg()
80
77
72
68
65
60
62
60
53
48
Proportion of patients ()
40

39
38
24
20
22
21
18
12
0
ALTlt1 x ULN
Histologic improvement
HBeAg seroconversion
Biopsy taken at 72 weeks.
Lok ASF McMahon B. Hepatology 2007
45(2)507539.
15
???????????????
Collation of currently available data not
from head-to-head studies
HBeAg(-)
80
78
74
71
72
67
60
64
61

Proportion of patients ()
48
40
38
20
0
ALTlt1 x ULN
Histologic improvement
Biopsy taken at 72 weeks.
Lok ASF McMahon B. Hepatology 2007
45(2)507539.
16
????????????????
GLOBE??
50
HBeAg()
HBeAg()
45
39
40
????
????
35
30
1???()
25
25
20
20
13
13
15
10
10
7
7
7
6
5
5
2
1
1
0
0
0
ltLOQ
LOQ3 log
34 log
gt4 log
ltLOQ
LOQ3 log
34 log
gt4 log
24?HBV DNA
Lai CL, et al. Hepatology 2005 42(suppl
1)232A233A (Abstract 92)
17
????????????
18
????????????????
????????????????
lt

????,????,?????????????, ???????????????????
19
???????????????
?? Year 1 Year 2 Year 3 Year 4 ??
???? TT Chang ?? 58 ? 51 45 ????2007AASLD????,?????ITT??,????????????
???? TT Chang ?? 17 40 57 67 ????2007AASLD????,?????ITT??,????????????
???? Anna Lok????? ?? 998 796 688 592 ???????????????,???????K-M??????????
???? Anna Lok????? ?? 16 36 56 75 ???????????????,???????K-M??????????
???? Stephanos J. Hadziyannis ?? 183 134 118 60-70 ??HBeAg-?????,??????????????
???? Stephanos J. Hadziyannis ?? 0 3 11 18 ??HBeAg-?????,??????????????
???? Colonno ?? 663 278 149 120 ??/???????????????,??????????????????????????
???? Colonno ?? lt1 lt1 lt1 1.2 ??/???????????????,??????????????????????????
???? ?? 680 680? ?????ITT?????,???1???2??????????.????????????????, ????????????
???? ?? 5.3-11.3 8.6-21.6 NA NA ?????ITT?????,???1???2??????????.????????????????, ????????????
20
ETV????????663?120???
1.????????? 2.?????? 3.???? 4.???? 5.??Omata
??????
21
?????????????????
Add on?On what and how? Switch to?To what?
22
????ETV?????????????
100
??????
80
60
Percent
40
20
0
Yr 1 (n663)
Yr 2 (n278)
Yr 3 (n149)
Yr 4 (n120)
ETVr LVDr (M204V L180M) T184, S202 ?/? M250
??
ETVr ????? (??????1 log)
Miller RG Jr, Survival Analysis New York John
Wiley Sons Inc. 1981
23
?LVD???ETV???
????????
100
80
60
???
40
20
19
16
15
1
10
9
8
6
0
Yr 1 (n187)
Yr 2 (n146)
Yr 3 (n80)
Yr 4 (n53)
ETVr LVDr (M204V L180M) T184, S202 ?/? M250
??
ETVr ????? (??????1 log)
Miller RG Jr, Survival Analysis New York John
Wiley Sons Inc. 1981
24
????????????
180
184 or 202 or 250
204
LVD
then ETV
???????
????
US Prescribing Information for Epivir-HBV
(2004), Hepsera (Aug 2006), Baraclude (July
2006) Colonno R, et al. Hepatology
200644(Suppl. 1)Abstract 110
25
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