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Clinical evaluation of lamivudine therary in patients with chronic hepatitis B based on a long-term outcome : Comparison with entecavir therary Ishikawa, Kazuyoshi Nitatori, Tohru Isobe, Naoko Nakakarumai, Chihoko open access 慢性B型肝炎 核酸アナログ/アミノ酸置換 viral breakthrough breakthrough hepatitis chronic hepatitis B nucleoside analog amino acid substitution viral breakthrough breakthrough hepatitis B型慢性肝炎においてLAMの治療を行い5年以上の追跡を行った6例(LAM群)と、その後新たにETVの治療を開始した10例(ETV群)を対象とした。両群の背景に差は認められなかった。LAM群は100mg/日を経口投与され、治療開始6ヵ月以内にHBV-DNAの消失をみたのは4例(67%)であった。他の2例はETVに切替後にHBV-DNAの消失をみたが、その後の経過は良好であった。LAM耐性のrt204のアミノ酸置換が2例に検出され、VBTを示したがBTHは認められなかった。ETV群は0.5mg/日を経口投与され、治療開始6ヵ月以内にHBV-DNAの消失をみたのは9例(90%)で、他の1例も療開始後7ヵ月でHBV-DNAの消失をみた。全例VBTもBTHも認められず、以後の経過は良好であった、したがって現時点では、新規治療例の第一選択薬はETVが妥当と考えられる。しかしLAM治療例においても、長期にわたりHBV-DNA量が検出感度以下を持続し臨床経過が安定している例や、LAM耐性株出現例でもBTHを示さない例が存在する。したがって早急な薬剤の変更は新たなETV耐性を生むという観点からも避けるべきと考えられる。 This study evaluated 6 patients treated with LAM for chronic hepatitis B and followed for at least 5 years (LAM group), and 10 patients who were later started on ETV (ETV group). Background factors did not significantly differ between the two groups. In the LAM group, the dose was 100 mg/day orally, and within 6 months after starting treatment, HBV-DNA disappeared in 4 patients (67%). In the other 2 patients, after switching to ETV, HBV disappeared, and the subsequent clinical course was good. LAM-resistance rt204 amino acid substitutions were detected in 2 patients; VBT developed, but no BTH was observed. In the ETV group, the dose was 0.5 mg/day orally, and within 6 months after starting treatment, HBV-DNA disappeared in 9 patients (90%). In the remaining patient, at 7 months after starting treatment, HBV-DNA also disappeared. Neither VBT nor BTH was observed in any patient, and the subsequent clinical course was good. Therefore, at the present time, ETV is reasonable first-choice drug in newly treated patients. However, among some LAM-treated patients over a long period, HBV-DNA has remained below the detectable level, with a stable clinical course; and even with emergence of LAM resistance, BTH has not occurred. Accordingly, from the viewpoint of possible new emergence of ETV resistance, unnecessary switching of drugs should be avoided. 3 KJ00008051119 原著 2012-01-01 eng departmental bulletin paper https://iwate-pu.repo.nii.ac.jp/records/1844 AA11373559 13449745 岩手県立大学看護学部紀要 Journal of the Faculty of Nursing, Iwate Prefectural University 14 1 11 https://iwate-pu.repo.nii.ac.jp/record/1844/files/KJ00008051119.pdf application/pdf 4.6 MB 2016-12-27