| 特集名 | B型肝炎 update 2004 | |
|---|---|---|
| 題名 | B型肝炎の治療 update (4) ラミブジン以外の抗HBV薬の国内外における現況 | |
| 発刊年月 | 2004年 10月 | |
| 著者 | 鈴木 義之 | 虎の門病院消化器科 |
| 著者 | 熊田 博光 | 虎の門病院消化器科 |
| 【 要旨 】 | ラミブジン投与におけるbreakthrough hepatitisの問題が議論の対象となって以来，ポストラミブジンとして新たな抗ウィルス薬の登場が望まれてきた．最近になりようやく実用可能な二つの薬剤が登場し，本邦でも臨床治験が進行中である．現在の進行状況からは，ラミブジン耐性株に対してアデフォビルディピボキシルもエンテカビルもともに有効であり，安全性の面からも重篤な副作用は認められていない．どちらの薬剤がラミブジン耐性株に対する第一選択となるかは，今後大いに検討していかなければならない課題である， | |
| Theme | Hepatitis B Update 2004 | |
|---|---|---|
| Title | Nucleoside Analogue for Treatment of Breakthrough Hepatitis Caused by Lamivudine Resistant Mutations of Hepatitis B Virus | |
| Author | Yoshiyuki Suzuki | Department of Gastroenterology, Toranomon Hospital |
| Author | Hiromitsu Kumada | Department of Gastroenterology, Toranomon Hospital |
| [ Summary ] | Lamivudine is an oral nucleoside analogue with potent antiviral activity. It prohibits the replication of the hepatitis B virus (HBV), and induces strong antiviral activity as well as improvements in liver function in patients with chronic hepatitis B. Since the therapeutic efficacy of lamivudine is reflected most reliably by histological improvement, this has been regarded as the ´gold standard´ in evaluating treatment response. However, the emergence of lamivudine resistant HBV strains in patients on long term lamivudine therapy has been observed, and such resistant mutation occurs in the HBV DNA polymerase gene. The emergence of such mutant viruses results in the reelevation of HBV DNA and ALT, and causes clinical and histologic progression. Mutants resistant to lamivudine emerged in parallel with the duration of lamivudine, as reported by others. Adefovir dipivoxil (ADV) and Entecavir (ETV) are nucleoside analogues that selectively inhibit viral polymerases and reverse transcriptases. These drugs display antiviral activity against not only wild type HBV but also lamivudine resistant HBV mutations. In these studies, the administration of ADV add-on to lamivudine for patients with breakthrough hepatitis reduced HBV DNA and ALT levels. ETV reduced HBV DNA and ALT levels in patients with breakthrough hepatitis. |
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