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Điều trị kháng virus trong không đáp ứng, relapsers và dân số đặc biệt | 49 và đến một mức độ ít hơn, trước khi không đáp ứng trong giai đoạn thử nghiệm III. Trình bày chi tiết mới aproved trực tiếp tác dụng thuốc chống siêu vi (DAAs) được đưa ra trong chương 4. | Antiviral therapy in non-responders relapsers and special populations 49 and to a lesser extent prior non-responders in phase III trials. A detailed presentation of the newly aproved direct-acting antivirals DAAs is given in chapter 4. Prove-3 trial evaluated triple-combination therapy with telaprevir in treatment-experienced patients 60 nonresponders and 40 relapsers McHutchison 2010 . Patients were randomized on four treatment arms in order to assess the impact of different durations of triple therapy different total treatment duration and the importance of RBV for this difficult-to-treat population. Prior relapsers treated with 24 weeks of triple therapy followed by 24 weeks of PegIFN RBV total duration of therapy 48 weeks had a SVR rate of 76 while prior non-responders had lower rates of SVR 40 . RESPOND-2 evaluated triple therapy combination with boceprevir in non-responders and relapsers Bacon 2011 . The results indicate that 75 of prior relapsers and 52 of prior nonresponders treated with a fixed triple therapy boceprevir regimen achieved SVR. In the response-guided arm SVR was 69 in prior relapsers and 40 in prior non-responders. Curent available data clearly show that that triple therapies including a protease inhibitor provide higher chance of SVR for relapsers and non-responders. The benefits of these novel treatment regimens for each individual patient must be weighed against the side effects costs and potential of developing viral resistance. Practical approach to retreatment When deciding retreatment of previous non-sustained responders to standard therapy the following practical issues should be considered - Patient s motivation for another course of therapy. Lower likelihood of SVR in treatment-experienced patients side effects poor QoL should be discussed with the patient - Severity of liver disease clinical biochemical histological . Patients with minimal-to-moderate fibrosis This is trial version www.adultpdf.com 50 Hepatitis C Treatment may wait
