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Boceprevir early-access for advanced-fibrosis/cirrhosis inAsia-pacific hepatitis C virus genotype 1 non-responders/relapsers 预览
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作者 Wattana Sukeepaisarnjaroen, Tri Pham, Tewesak Tanwandee, Saroja Nazareth, Sam Galhenage, Lindsay Mollison, Leanne Totten, Alan Wigg, Rosalie Altus, Anton Colman, Brenda Morales, Sue Mason, Tracey Jones, Nadine Leembruggen, Vince Fragomelli, Cheryl Sendall, Richard Guan, Dede Sutedja, Soek Siam Tan, Yock Young Dan, Yin Mei Lee, Widjaja Luman, Eng Kiong Teo, Yin Min Than, Teerha Piratvisuth, and Seng Gee Lim 《世界胃肠病学杂志:英文版(电子版)》 SCIE CAS 2015年第28期8660-8669,共10页
AIM To examined the efficacy and safety of treatmentwith boceprevir, PEGylated-interferon and ribavirin (PR)in hepatitis C virus genotype 1 (HCVGT1) PR treatmentfailuresin Asia.METHODS: The Boceprevir Named-Patie... AIM To examined the efficacy and safety of treatmentwith boceprevir, PEGylated-interferon and ribavirin (PR)in hepatitis C virus genotype 1 (HCVGT1) PR treatmentfailuresin Asia.METHODS: The Boceprevir Named-Patient Programprovided boceprevir to HCVGT1 PR treatment-failures.Participating physicians were invited to contributedata from their patients: baseline characteristics, ontreatmentresponses, sustained virological responseat week 12 (SVR12), and safety were collected andanalysed. Multivariate analysis was performed todetermine predictors of response.RESULTS: 150 patients were enrolled from Australia,Malaysia, Singapore and Thailand (Asians = 86,Caucasians = 63). Overall SVR12 was 61% (Asians= 59.3%, Caucasians = 63.5%). SVR12 was higherin relapsers (78%) compared with non-responders(34%). On-treatment responses predicted SVR, withundetectable HCVRNA at week 4, 8 and 12 leading toSVR12s of 100%, 87%, and 82% respectively, anddetectable HCVRNA at week 4, 8 and 12, leading toSVR12s of 58%, 22% and 6% respectively. Asianpatients were similar to Caucasian patients with regardsto on-treatment responses. Patients with cirrhosis (n= 69) also behaved in the same manner with regardsto on-treatment responses. Those with the IL28B CCgenotype (80%) had higher SVRs than those withthe CT/TT (56%) genotype (P = 0.010). Multivariateanalysis showed that TW8 and TW12 responses wereindependent predictors of SVR. Serious adverse eventsoccurred in 18.6%: sepsis (2%), decompensation(2.7%) and blood transfusion (14%). Discontinuationsoccurred in 30.7%, with 18.6% fulfilling stopping rules.CONCLUSION: Boceprevir can be used successfullyin PR treatment failures with a SVR12 〉 80% ifthey have good on-treatment responses; however,discontinuations occurred in 30% because of virologicalfailure or adverse events. 展开更多
关键词 Chronic hepatitis C Treatment failure Rapid virological RESPONSE LEAD-IN Null RESPONSE Partial RESPONSE RELAPSE CIRRHOSIS RESPONSE guidedtherapy
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Alanine aminotransferase is an inadequate surrogate marker for detecting lamivudine resistance 预览
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作者 Lee Guan Lim Myat Oo Aung +8 位作者 Bee Leng Seet Cindy Tan Yock Young Dan Yin Mei Lee Dede Selamat Sutedja Mark Fernandes Guan Huei Lee Evelyn Koay Seng Gee Lim 《世界胃肠病学杂志:英文版(电子版)》 SCIE CAS CSCD 2010年第37期共6页
AIM: To investigate the accuracy of serum alanine aminotransferase (ALT) in diagnosing lamivudine resistance and factors that contributed to abnormal serum ALT.METHODS: This was a retrospective study of chronic hepati... AIM: To investigate the accuracy of serum alanine aminotransferase (ALT) in diagnosing lamivudine resistance and factors that contributed to abnormal serum ALT.METHODS: This was a retrospective study of chronic hepatitis B patients on lamivudine therapy who were followed for 3-mo with liver function tests and hepatitis B virus (HBV) DNA measurement. Lamivudine resistance was defined as HBV DNA ≥ 1 log from nadir on at least 2 occasions, confirmed by genotyping. Serum ALT levels in patients with lamivudine resistance were compared to serum ALT levels in those without lamivudine resistance. RESULTS: There were 111 patients with and 117 without lamivudine resistance. The area under the receiver operating characteristic of serum ALT to diagnose lamivudine resistance was 0.645 ± 0.037. Serum ALT > 42.5 U/L gave the best diagnostic accuracy with sensitivity = 61%, specificity = 60%, positive predictive value = 60%, negative predictive value = 61%, positive likelihood ratio = 1.53 and negative likelihood ratio = 0.65 for predicting lamivudine resistance, missing 39% of resistant patients. Using other serum ALT cutoffs, diagnostic accuracy was lower. By multivariate analysis, baseline abnormal serum ALT was associated with abnormal ALT during resistance (OR = 5.98, P = 0.003), and males were associated with serum ALT flares during resistance (OR = 8.9, P = 0.016). CONCLUSION: Serum ALT is inadequate for diagnosing lamivudine resistance and has implications where viral resistance testing is suboptimal and for reimbursement of rescue therapy. 展开更多
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Acute-on-chronic liver failure in a multi-ethnic Asian city:A comparison of patients identified by Asia-Pacific Association for the Study of the Liver and European Association for the Study of the Liver definitions 预览
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作者 Anandraj Selva Rajoo Seng-Gee Lim +7 位作者 Wah Wah Phyo Thandar Tun Yock-Young Dan Yin-Mei Lee How-Cheng Low Kieron Lim Poh-Seng Tan Guan-Huei Lee 《世界肝病学杂志:英文版(电子版)》 2017年第28期1133-1140,共8页
AIM To explore the applicability of the Asia-Pacific Association for the Study of the Liver(APASL) and European Association for the Study of the Liver(EASL) guidelines for acute-on-chronic liver failure(ACLF) in profi... AIM To explore the applicability of the Asia-Pacific Association for the Study of the Liver(APASL) and European Association for the Study of the Liver(EASL) guidelines for acute-on-chronic liver failure(ACLF) in profiling patients and determining the outcome.METHODS Patients admitted to a tertiary hospital in Singapore with acute decompensation of liver disease from January 2004to July 2014 are screened for ACLF according to the APASL and EASL criteria. The patients’ data(including basic demographics, information about existing chronic liver disease, information about the acute decompensation, relevant laboratory values during admission, treatment, and outcome) are retrospectively analyzed to determine the background, precipitating factors and outcome.RESULTS A total of 458 liver patients is analyzed, and 78 patients with ACLF are identified. Sixty-three patients(80.8%) meet the APASL criteria, 64 patients(82.1%) meet the EASL criteria, and 49 patients(62.8%) fulfilled both criteria. The most common causes of acute liver injury are bacterial infections(59.0%), hepatitis B flare(29.5%), and variceal bleeding(24.4%). The common aetiologies of the underlying chronic disease included hepatitis B(43.6%), alcoholic(20.5%) and cryptogenic(11.5%) liver disease. The overall mortality rate is 61.5%. Increased age, the number of organ failures(as per CLIF-SOFA score), peak creatinine, INR, and amylase levels are associated with increased mortality or the need for liver transplantation. 14.3% of patients undergo liver transplantation with a 100% 1-year survival rate. CONCLUSION Both APASL and EASL criteria have identified ACLF patients with high three-month mortality, but those who fulfill APASL criteria alone have a better survival. 展开更多
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