İmmunsupresif ilaç kullanımı nedeni ile profilaktik tedavi alan kronik hepatit B hastalarında oral antivirallerin etkinliklerinin retrospektif olarak değerlendirilmesi
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Dosyalar
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Günümüzde immün sistemi baskılayan ilaçlar yaygın olarak
kullanılmaktadır. Hepatit B virüs (HBV) serolojisi pozitif olan hastalarda, immünsupresif
tedaviler sonrasında HBV reaktivasyonu ortaya çıkabilmektedir. Güncel kılavuzlarda HBV
reaktivasyonu riski taşıyan hastalara profilaktik antiviral tedavi verilmesi önerilmektedir.
Bu çalışmada immunsupresif tedavi almaları nedeniyle profilaktik antiviral tedavi
başlanmış olan hastalarda tenofovir disoproksil fumarat (TDF), tenofovir alafenamid
(TAF) ve entekavirin (ETV) etkinliklerinin değerlendirilmesi amaçlanmıştır.
Yöntem: Ocak 2017-Eylül 2021 tarihleri arasında NEÜ Meram Tıp Fakültesi
Gastroenteroloji kliniğine başvuran, immunsupresif tedavi alan, HBV serolojisinin (+)
olması nedeniyle profilaktik antiviral tedavi başlanan 174 hasta çalışmaya alındı ve verileri
retrospektif olarak değerlendirildi.
Bulgular: Çalışmadaki 174 olgunun 113’ü TDF, 39’u ETV, 22’si TAF tedavisi
almıştı. Dokuz hastada (%5,2) HBV reaktivasyonu geliştiği saptandı. Reaktivasyon gelişen
olgularda tedavi öncesi HBV DNA ve HBsAg pozitifliği sıklığı istatistiksel olarak anlamlı
düzeyde daha yüksek (p<0,05) ve antiHBs pozitifliği sıklığı anlamlı düzeyde daha azdı
(p<0,05). TDF alanlarlarda %7,1, entekavir alanlarda %2,6 reaktivasyon görülürken, TAF
grubunda reaktivasyon görülmedi; tedavi grupları arasında reaktivasyon gelişme sıklığı
bakımından istatistiksel olarak anlamlı fark yoktu (p>0,05). TDF alan hastalarda tedavi
sonrasında serum fosfor düzeyi ve GFR azalırken serum kreatinin düzeyinin arttığı
(p<0,05), TAF alan hastalarda ise tedavi sonrasında serum kreatinin düzeyinin azaldığı ve
GFR’nin arttığı görüldü (p<0,05). Lojistik regresyon analizinde reaktivasyon açısından
bağımsız risk faktörü tespit edilemedi.
Sonuç: İmmünsuresif tedavi alan ve HBV serolojisi pozitif olan hastalarda HBV
reaktivasyonu görülebilir. Bu nedenle immünsupresif tedavi alacak hastalarda HBV
serolojisi taranmalı ve risk grubundaki hastalara profilaktik antiviral tedavi verilmelidir.
TDF, ETV ve TAF immünsupresif tedavi alan hastalarda HBV reaktivasyonunu
engellemede oldukça etkilidir
Introduction: Nowadays, drugs that suppress the immune system are widely used. In patients with positive hepatitis B virus (HBV) serology, HBV reactivation may occur after immunosuppressive treatments. Current guidelines recommend prophylactic antiviral therapy for patients at risk of HBV reactivation. In this study, it was aimed to evaluate the prophylactic efficacy of tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), and entecavir (ETV) in patients receiving immunosuppressive therapies. Methods: One hundred and seventy four patients who applied to NEU Meram Medical Faculty Gastroenterology clinic, received immunosuppressive therapy and started prophylactic antiviral therapy due to HBV serology (+) were included in the study, and their data were evaluated retrospectively. Results: Of the 174 patients in the study, 113 received TDF, 39 received ETV, and 22 received TAF. HBV reactivation was observed in 9 (5.2%) patients. The rates of HBV DNA and HBsAg positivity before the treatment were significantly higher (p<0.05), and the rate of antiHBs positivity was significantly lower (p<0.05) in patients with reactivation. Reactivation was observed in 7.1% of patients receiving TDF and 2.6% of patients receiving entecavir, no reactivation was observed in the TAF group; the difference between the groups was not statistically significant (p>0.05). Serum phosphorus level and GFR were found to decrease and serum creatinine levels were found to increase after TDF treatment (p<0.05). On the other hand serum creatinine levels were found to decrease and GFR was found to increase after TAF treatment (p<0.05). No independent risk factor for reactivation was detected in the logistic regression analysis. In conclusion: HBV reactivation may occur in patients with positive HBV serology receiving immunosuppressive therapies. Therefore, HBV serology should be screened in all patients receiving immunosuppressive therapies, and prophylactic antiviral therapy should be given to patients at risk. TDF, ETV, and TAF are highly effective in preventing HBV reactivation in patients receiving immunosuppressive therapy.
Introduction: Nowadays, drugs that suppress the immune system are widely used. In patients with positive hepatitis B virus (HBV) serology, HBV reactivation may occur after immunosuppressive treatments. Current guidelines recommend prophylactic antiviral therapy for patients at risk of HBV reactivation. In this study, it was aimed to evaluate the prophylactic efficacy of tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), and entecavir (ETV) in patients receiving immunosuppressive therapies. Methods: One hundred and seventy four patients who applied to NEU Meram Medical Faculty Gastroenterology clinic, received immunosuppressive therapy and started prophylactic antiviral therapy due to HBV serology (+) were included in the study, and their data were evaluated retrospectively. Results: Of the 174 patients in the study, 113 received TDF, 39 received ETV, and 22 received TAF. HBV reactivation was observed in 9 (5.2%) patients. The rates of HBV DNA and HBsAg positivity before the treatment were significantly higher (p<0.05), and the rate of antiHBs positivity was significantly lower (p<0.05) in patients with reactivation. Reactivation was observed in 7.1% of patients receiving TDF and 2.6% of patients receiving entecavir, no reactivation was observed in the TAF group; the difference between the groups was not statistically significant (p>0.05). Serum phosphorus level and GFR were found to decrease and serum creatinine levels were found to increase after TDF treatment (p<0.05). On the other hand serum creatinine levels were found to decrease and GFR was found to increase after TAF treatment (p<0.05). No independent risk factor for reactivation was detected in the logistic regression analysis. In conclusion: HBV reactivation may occur in patients with positive HBV serology receiving immunosuppressive therapies. Therefore, HBV serology should be screened in all patients receiving immunosuppressive therapies, and prophylactic antiviral therapy should be given to patients at risk. TDF, ETV, and TAF are highly effective in preventing HBV reactivation in patients receiving immunosuppressive therapy.
Açıklama
Anahtar Kelimeler
Kronik hepatit B, İmmunsupresif tedavi, Oral antiviral ilaçlar, Chronic hepatitis B, Immunosuppressive therapy, Oral antiviral drugs
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Anasız, F. C. (2022). İmmunsupresif ilaç kullanımı nedeni ile profilaktik tedavi alan kronik hepatit B hastalarında oral antivirallerin etkinliklerinin retrospektif olarak değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
