Kronik hepatit B hastalarında oral antiviral ilaçların karşılaştırılması
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Date
2015
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Düzce Üniversitesi
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Abstract
Hepatit B virüs enfeksiyonu dünyada olduğu gibi ülkemizde de önemli bir halk sağlığı sorunudur. Mevcut antiviral tedaviler virüsü baskılamakta ancak tamamen eradike edememektedir. Bu çalışmada; Düzce Üniversitesi Sağlık Araştırma ve Uygulama Merkezi Enfeksiyon Hastalıkları Kliniği'nde takipli kronik hepatit B tanılı hastalarda oral antivirallerin etkinliği araştırılmıştır. En az altı ay oral antiviral kullanan hastaların demografik özellikleri, virolojik, serolojik, biyokimyasal değerleri ve ilaç yan etkileri dosyaları retrospektif taranarak kayıt edildi. Oransal ve istatistiksel karşılaştırmaları yapıldı. Çalışmadaki 119 hastanın 85'i erkek, 34'ü kadın olup; genel yaş ortalaması 43,7±11'di. Hastalardan 59'u tenofovir, 30'u entekavir, 21'i lamivudin, 5'i telbivudin, 4'ü adefovir kullanmıştı. Tedavi öncesi 80 hasta HBeAg negatif, 39 hasta HBeAg pozitifdi. Birinci yılda; HBeAg pozitif grupta virolojik yanıt oranı en yüksek entekavir (%70), HBeAg negatif grupta tenofovir (%86,1) kullananlarda görülürken tüm hastalarda lamivudinde (%75) en yüksek orandaydı ancak başlangıç HBV DNA ortalaması en düşük lamivudin grubuydu. Ayrıca tenofovirin, lamivudin ve entekavirden daha hızlı virolojik (p=0,001) ve biyokimyasal (p<0.001) yanıt sağladığı görüldü. Beşinci yılda üç ilacın etkinlikleri yüksek ve birbirine yakındı. Lamivudin, entekavir, tenofovirde sırasıyla %100, %100, %80 virolojik ve her üç antiviralde %100 biyokimyasal yanıt görüldü. Birinci yılda görülen tenofovirdeki farkın üçüncü yılda görülmediği ve gruplar arasında birinci yıldan sonra fark olmadığı tespit edildi. Tedavi uyumunda ilaçlar arasında istatistiksel fark olmamakla birlikte tenofovir kullananlarda uyumsuzluk en yüksek orandaydı. Sonuç olarak günümüzde kullanılan tenofovir ve entekavir gibi potent antiviraller bizim çalışmamızda da etkin bulunmuştur. Lamivudin hala etkin bir tedavi gibi görünse de literatürlere göre direnç önemli bir sorundur. İlaç uyumu tedavi başarısında oldukça önemlidir.
The infection of hepatitis B virus is a common problem of community's health in our country as well as in the world. Present antiviral treatments repress the virus but cannot totally eradicate. In this survey, oral antiviral activity of patients who were diagnosed as chronic hepatitis B and under observation were investigated in Duzce University Health Research and Application Center Infectious Disease Clinic. The files of patients who had taken oral antiviral at least six months were recorded by being scanned retrospectively. These files include patients' demographic features, virologic and serologic biochemical values and side effects of medicines. Proportional and statistical comparison of these data were made. In this survey, there were 85 male and 34 female patients, and their age average was 43,7±11. Among these total 119 patients, 59 patients had used tenofovir, 30 patients had used entecavir, 21 had used lamivudine, 5 patients had used telbivudine and 4 of them had used adefovir. Before the treatment, 80 patients' HBeAg values were negative and 39 patients' were positive. In the first year of treatment, while the highest virological response rate was observed in patients who had used entecavir (%70) in HBeAg-positive group and who had used tenofovir (%86.1) in HBeAg-negative group, the highest response rate among all patients was for lamivudine (%75). However; lamivudine group had the lowest beginning HBV DNA average at the same time. In addition to, tenofovir causes faster virological (p=0.001) and biochemical (p<0.001) response than lamivudine and entecavir was observed. In the 5th year, these three medicines' activities were high and nearly at the same level. While virological response of lamivudine, entecavir and tenofovir were 100%, 100% and 80% successively, biochemical response was 100% for these three antivirals. The difference of tenofovir observed in the first year disappeared in the third year and it was recorded that there was no difference among these groups after the first year. Although there was no statistical difference for treatment adaptation among these medicines, the maladaptation was at the highest level for tenofovir users. In conclusion, the potent antivirals used recently such as tenofovir and entecavir were found beneficial in this survey as well. Although lamivudin is accepted as an efficient treatment, the resistance is an important problem as seen in literature. The medicine adaptation is quite important for the success of the treatment.
The infection of hepatitis B virus is a common problem of community's health in our country as well as in the world. Present antiviral treatments repress the virus but cannot totally eradicate. In this survey, oral antiviral activity of patients who were diagnosed as chronic hepatitis B and under observation were investigated in Duzce University Health Research and Application Center Infectious Disease Clinic. The files of patients who had taken oral antiviral at least six months were recorded by being scanned retrospectively. These files include patients' demographic features, virologic and serologic biochemical values and side effects of medicines. Proportional and statistical comparison of these data were made. In this survey, there were 85 male and 34 female patients, and their age average was 43,7±11. Among these total 119 patients, 59 patients had used tenofovir, 30 patients had used entecavir, 21 had used lamivudine, 5 patients had used telbivudine and 4 of them had used adefovir. Before the treatment, 80 patients' HBeAg values were negative and 39 patients' were positive. In the first year of treatment, while the highest virological response rate was observed in patients who had used entecavir (%70) in HBeAg-positive group and who had used tenofovir (%86.1) in HBeAg-negative group, the highest response rate among all patients was for lamivudine (%75). However; lamivudine group had the lowest beginning HBV DNA average at the same time. In addition to, tenofovir causes faster virological (p=0.001) and biochemical (p<0.001) response than lamivudine and entecavir was observed. In the 5th year, these three medicines' activities were high and nearly at the same level. While virological response of lamivudine, entecavir and tenofovir were 100%, 100% and 80% successively, biochemical response was 100% for these three antivirals. The difference of tenofovir observed in the first year disappeared in the third year and it was recorded that there was no difference among these groups after the first year. Although there was no statistical difference for treatment adaptation among these medicines, the maladaptation was at the highest level for tenofovir users. In conclusion, the potent antivirals used recently such as tenofovir and entecavir were found beneficial in this survey as well. Although lamivudin is accepted as an efficient treatment, the resistance is an important problem as seen in literature. The medicine adaptation is quite important for the success of the treatment.
Description
YÖK Tez No: 406832
Keywords
Klinik Bakteriyoloji ve Enfeksiyon Hastalıkları, Clinical Microbiology and Infectious Diseases, Antiviral ajanlar, Antiviral agents, Entekavir, Entecavir, Hepatit, Hepatitis, Hepatit B, Hepatitis B, Hepatit B, Hepatitis B, Lamivudine, Lamivudine, Tenofovir, Tenofovir, İlaç allerjisi, Drug hypersensitivity, İlaçlar, Drugs, Kronik hepatit B, antiviral, lamivudin, entekavir, tenofovir, Chronic hepatitis B, antiviral, lamivudine, entecavir, tenofovir
