Necati YENİCE, ÖZGÜR MEHTAP, Nurten ARICAN, Yasemin GÖKDEN

Kronik hepatit B enfeksiyonunda lamivudin monoterapisi, interferon alfa monoterapisi ve kombinasyon tedavisi

Giriş ve amaç: Bu çalışmada, HBeAg pozitif ve HBeAg negatif kronik hepatit B hastalarında lamivudin monoterapisi, interferon alfa monoterapisi ve bunların kombinasyonunun etkinliklerinin değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: 2002 ve 2004 yılları arasında çalışmaya toplam 128 hasta alınmış [65 HBeAg-pozitif ve 63 HBeAg-negatif]; 21 hastaya lamivudin monoterapisi (HBeAg-pozitif = 11, HBeAg-negatif = 10); 40 hastaya interferon alfa monoterapisi (HBeAg-pozitif = 23, HBeAg-negatif = 17) ve 67 hastaya (HBeAg-pozitif = 29, HBeAg-negatif = 38) kombinasyon tedavisi verilmiştir. Lamivudin monoterapisi alan hastalara beş yıl, interferon monoterapisi ve kombinasyon tedavisi alan gruba bir yıl takip ve tedavi düzenlenmiştir. Hastaların tedavi altında iken altıncı aydaki virolojik yanıtlar, biyokimyasal yanıtlar ve serokonversiyon oranları değerlendirilmiştir. Bulgular: HBeAg pozitif hastalarda, lamuvidin monoterapisi ile hastaların %36.4’ünde, interferon monoterapisi ile %47.8’inde ve kombinasyon tedavisi ile %89.7’sinde HBV DNA kaybı gözlenmiştir. (p < 0.01, kombinasyon tedavisi lamivudin ve interferon ile karşılaştırıldığına). Tedavi grupları arasında serokonversiyon ve ALT normalizasyon oranları açısıdan anlamlı fark yoktur. HBeAg-negatif hastalarda ise HBV DNA kaybı ve serokonversiyon oranları açısıdan tedavi grupları arasında anlamlı hiçbir fark bulunmamıştır. Sonuç: Erken sonuçlarımız lamivudin-interferon kombinasyonunun, tek başına lamivudin ya da interferon ile karşılaştırıldığında, HBeAg pozitif hastalarda daha yüksek virolojik yanıtlar sağlayabileceğini göstermektedir. Ancak prekor mutant vakalarda kombinasyon lehine böyle bir farklılık gözlenmemiştir.

Anahtar Kelimeler:

Kronik hepatit B, lamivudin, interferon, kombinasyon, prekor mutant

Lamivudine monotherapy, interferon alpha monotherapy and combination therapy in chronic hepatitis B infection

Background/aim: This study aims to evaluate the efficacy of lamivudine and interferon alpha monotherapies and their combination in HBeAgpositive and HBeAg-negative chronic hepatitis B. Materials and methods: Between 2002 and 2004, a total of 128 patients [65 HBeAgpositive and 63 HBeAg-negative] were enrolled; 21 patients received lamivudine monotherapy (HBeAg-positive = 11, HBeAg-negative = 10), 40 received interferon-alpha monotherapy (HBeAg-positive = 23, HBe- Ag-negative = 17), and 67 received the combination (HBeAg-positive = 29, HBeAg-negative = 38). The virologic responses, biochemical responses, and seroconversion rates were evaluated after 6 months. Results: In HBeAg-positive patients, HBV DNA loss was observed in 36.4%, 47.8% and 89.7% of patients after lamivudine monotherapy, interferon monotherapy and combination therapy, respectively (p

Keywords:

Chronic hepatitis B, lamivudine, interferon, combination, precore mutant,

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