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Id: biblio-887224
Autor: Saeedi, Ramesh; Mojebi-Mogharar, Ali; Sandhu, Supna K; Dubland, Joshua A; Ford, Jo-Ann; Yousefi, Masoud; Pudek, Morris; Holmes, Daniel T; Erb, Siegfried R; Kwan, Wing C. Peter; Kendler, David L; Yoshida, Eric M.
Título: Lamivudine, Entecavir, or Tenofovir Treatment of Hepatitis B Infection: Effects on Calcium, Phosphate, FGF23 and Indicators of Bone Metabolism
Fonte: Ann. hepatol;16(2):207-214, Mar.-Apr. 2017. tab, graf.
Idioma: en.
Resumo: ABSTRACT Background. Patients with chronic hepatitis B virus (HBV) are often treated with nucleoside/nucleotide antiviral agents and metabolic bone toxicity is a possible concern. Objective. To determine the relationships between fibroblast growth factor 23 (FGF23), a phosphaturic hormone, bone mineral density (BMD), and bone biochemical abnormalities in these patients. Material and methods. This is a cross-sectional observational study comparing HBV-infected subjects treated for at least one year with tenofovir (TDF), lamuvidine (LVD), entacavir (ETV), or not treated (CON). Patients with abnormalities in either calcium (Ca), phosphate (PO4), intact parathyroid hormone (iPTH) or FGF23 were further evaluated with BMD by DXA. Results. No difference in liver enzymes or renal function seen among groups, but hypophosphatemia was seen in all groups with the highest incidence with TDF treatment (14%). FGF 23 levels were found to be elevated in 11.1% of TDF patients, 2.77% amongst controls. No elevations were found in the LVD or ETV groups. Among a subset of subjects (FGF23, PO4, and/or Ca abnormalities) who underwent further evaluation, 67% had insufficient 25-OH vitamin D, and 30% had elevated 24 h urinary Ca or PO4 excretion. No patients with FGF23 abnormalities had urine abnormalities. 40% had low DXA Z-score (<-2) at spine or hip but there was no difference between control and antiviral treatment groups and the mean FRAX score was 2.33% for major osteoporotic fractures and 0.29% for hip fracture. Conclusion. Abnormalities in bone metabolism, particularly involving vitamin D insufficiency, in HBV-treated subjects were observed with a small increased likelihood in TDF treated patients.
Descritores: Antivirais/uso terapêutico
Fosfatos/sangue
Osso e Ossos/efeitos dos fármacos
Cálcio/sangue
Lamivudina/uso terapêutico
Hepatite B Crônica/tratamento farmacológico
Fatores de Crescimento de Fibroblastos/sangue
Tenofovir/uso terapêutico
Guanina/análogos & derivados
-Antivirais/efeitos adversos
Fatores de Tempo
Deficiência de Vitamina D/induzido quimicamente
Osso e Ossos/metabolismo
Osso e Ossos/diagnóstico por imagem
Biomarcadores/sangue
Absorciometria de Fóton
Densidade Óssea/efeitos dos fármacos
Estudos Transversais
Fatores de Risco
Resultado do Tratamento
Remodelação Óssea/efeitos dos fármacos
Hepatite B Crônica/diagnóstico
Hepatite B Crônica/sangue
Fraturas Ósseas/induzido quimicamente
Tenofovir/efeitos adversos
Guanina/efeitos adversos
Guanina/uso terapêutico
Limites: Humanos
Responsável: BR1.1 - BIREME


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Id: biblio-1157368
Autor: Anders María; Orozco Federico; Goldaracena Nicolás; Quiñonez Emilio; McCormack Lucas; Mastai Ricardo.
Título: Eficacia de la asociación de una sola dosis de gamaglobulina hiperinmune anti-hepatitis B más entecavir en la profilaxis de la hepatitis B después del trasplante hepático: experiencia de un centro en la Argentina / [Efficacy of the association of a single dose of hepatitis B hyperimmune gammaglobulin and entecavir in the prophylaxis of hepatitis B after liver transplantation: experience of a single center in Argentina].
Fonte: Acta gastroenterol. latinoam;43(2):121-5, 2013 Jun.
Idioma: es.
Resumo: The present study reports the effectiveness of the association of a single dose of hepatitis B immunoglobulin (HBIg) associated to entecavir in the prophylaxis of hepatitis B in patients who have undergone liver transplantation. Six patients that had been transplanted because of hepatitis B liver disease were retrospectively evaluated. Three of them developed non-oncological complications related to liver cirrhosis, two had hepatocellular carcinoma and another one had fulminant HBV hepatitis. The mean follow-up was 22 months (range: 7-52 months). The 6 patients received entecavir as prophylactic treatment before transplantation. The pretransplant viral load was undetectable in all patients. HBsAg seroconversion was observed in four of the six patients. Three patients died during follow-up, two because of recurrent hepatocellular carcinoma, none of them had detectable HBV serum viral load. In a small series of patients we could demonstrate that a regimen with a single dose of gamma globulin entecavir is effective in the post-transplant management of patients with liver disease associated with HBV. Future studies will be able to demonstrate the effectiveness of specific gamma globulin-free regimens.
Descritores: Antivirais/administração & dosagem
Cirrose Hepática/cirurgia
Guanina/análogos & derivados
Hepatite B/prevenção & controle
Imunoglobulinas/administração & dosagem
Transplante de Fígado
-Adulto
Argentina
Cirrose Hepática/virologia
Estudos Retrospectivos
Feminino
Guanina/administração & dosagem
Humanos
Idoso
Masculino
Pessoa de Meia-Idade
Prevenção Secundária
Quimioterapia Combinada
Tipo de Publ: Resumo em Inglês
Artigo de Revista
Responsável: AR5.1 - Centro de Gestión del Conocimiento y las Comunicaciónes


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Id: lil-692409
Autor: Díaz Ferrer, Javier; Arcana, Ronald; Quinte, Danni; Bustios, Carla; Román, Rossana; Dávalos, Milagros; Zumaeta, Eduardo.
Título: Rebrote virológico en el tratamiento de hepatitis B con entecavir: ¿resistencia? / Virological breakthrough in treating hepatitis B with entecavir: It means resistance?
Fonte: Rev. gastroenterol. Perú;32(4):400-404, oct.-dic. 2012. ilus, tab.
Idioma: es.
Resumo: Paciente varón de 45 años natural de Lima, casado con antecedentes de , múltiples parejas sexuales y operado de fimosis, que debuta con eritema nodoso y diagnosticado de hepatitis B crónica en Agosto del 2008, en controles por consultorio se realiza diagnóstico de cirrosis hepática child A y hepatocarcinoma. Inicia tratamiento para la hepatitis B con Entecavir 0,5mg y luego se realiza hepatectomía del segmento V, En Febrero 2009 en controles de imágenes se evidencia recidiva de hepatocarcinoma en el segmento VI (lesión de 14mm) con AFP de 68 ng/dl, se realiza etanolización, con evolución final favorable. Durante el seguimiento no se observa evidencia de recidiva de HCC, continua con Entecavir 0,5 mg /d y en abril 2010, luego de 72 semanas de tratamiento con adecuada adherencia al tratamiento presenta rebrote virológico (carga viral positiva de 646 UI/dl), y se decide agregar a la terapia Tenofovir. Actualmente paciente con buena evolución con última carga viral de Abril del 2012 negativa recibiendo terapia doble para VHB. Reportamos el caso por ser uno de los primeros en nuestro país de resistencia probable a Entecavir y donde se pone de manifiesto la necesidad de examenes complementarios que confirmen dicha sospecha.

A 45 year- old - married man, with several sexual partners, initiated symptoms with nodosum erythema and in August 2008, is diagnosed of chronic hepatitis due to hepatitis B virus (HBV). Later he was diagnosed of Child A cirrhosis and hepatocarcinoma. He began HBV treatment with Entecavir 0,5 mg; then he underwent a V segment hepatectomy. In February 2009 he presented a relapse with a tumor of 14 mm on VI segment with AFP values of 68 ng/dl, so he underwent an ethanolization with good evolution. During the follow up, he has not presented evidence of relapse of hepatocarcinoma and continued with Entecavir 0,5 mg/d. In April 2010, after 72 weeks of therapy with good compliance, the patient presented a virological breakthrough (viral load 646 UI/dl) and Tenofovir was added to his therapy. Nowadays the patient is receiving double therapy for HBV and his last viral load, April 2012, was negative. This could be the first case in our country of a probable resistance to Entecavir; complementary tests are needed in order to rule out this suspicion.
Descritores: Antivirais/uso terapêutico
Farmacorresistência Viral
Guanina/análogos & derivados
Hepatite B Crônica/tratamento farmacológico
-Guanina/uso terapêutico
Hepatite B Crônica/diagnóstico
Hepatite B Crônica/virologia
Limites: Humanos
Masculino
Pessoa de Meia-Idade
Tipo de Publ: Relatos de Casos
Responsável: PE1.1 - Oficina Universitária de Biblioteca


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Texto completo SciELO Brasil
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Id: biblio-839267
Autor: Zhang, YR; Li, B; Wang, CX; Zhou, N; Qi, W; Li, XL; Wu, LY; Wei, SF; Zhang, YD.
Título: Influence of Treg cells and HBV genotype on sustained response and drug resistance in the treatment with nucleoside drugs
Fonte: Braz. j. med. biol. res = Rev. bras. pesqui. méd. biol;50(3):e5796, 2017. tab.
Idioma: en.
Projeto: Natural Science Funding of Gansu province.
Resumo: We aimed to investigate the influence of regulatory T cells including CD4+CD25+, CD8+CD28- and hepatitis B virus (HBV) genotype on sustained virological response and tolerance of nucleoside drugs. One hundred and thirty-seven patients were enrolled. Lamivudine was administered to 84 patients. Entecavir was administered to the other 53 patients. Before treatment, biochemical tests, HBV DNA load, HBV serum level, HBV genotype, PB CD3+, CD4+, CD8+, CD4+CD25+/CD3+, and CD8+CD28-/CD3+ frequencies were measured. Based on HBV DNA loads after 4 weeks of therapy, patients were divided into response group and suboptimal response group. The lamivudine group received treatment continuously, and then patients were categorized into non-resistance group and resistance group. Compared with the suboptimal response and resistance groups for lamivudine, CD4+CD25+/CD3+ levels were higher in the response and non-resistance groups (t=4.372, P=0.046; t=7.262, P=0.017). In the non-resistance group, CD8+CD28-/CD3+ frequency was lower than in the resistance group (t=5.527, P=0.037). Virus load and hepatitis B E antigen (HBeAg)-positive rate were significantly lower than in the response and resistance group (t=2.164, P=0.038; X2=4.239, P=0.040; t=2.015, P=0.044; X2=16.2, P=0.000). Incidence of drug resistance was high in patients with virogene type C. For the virological response to entecavir, CD8+CD28-/CD3+ level was significantly lower than that of the suboptimal response group (t=6.283, P=0.036). Response and suboptimal response groups were compared in CD3+, CD4+, CD8+, CD4+CD25+/CD3+ and virus genotype, and differences were not statistically significant (P>0.05). Baseline regulatory T cells including CD4+CD25+/CD3+ and CD8+CD28-/CD3+ frequencies have a relationship with the incidence of rapid virological response and the resistance to nucleoside drugs. Patients with HBV genotype C receiving lamivudine more often underwent drug resistance. Antiviral efficacy and the resistance to lamivudine were closely correlated with baseline factors; the same cannot be found for entecavir.
Descritores: Antivirais/uso terapêutico
Guanina/análogos & derivados
Vírus da Hepatite B/imunologia
Hepatite B Crônica/tratamento farmacológico
Lamivudina/uso terapêutico
Nucleosídeos/uso terapêutico
Linfócitos T Reguladores
-Resistência a Medicamentos
Genótipo
Guanina/uso terapêutico
Vírus da Hepatite B/efeitos dos fármacos
Hepatite B Crônica/virologia
Resposta Viral Sustentada
Linfócitos T Reguladores/imunologia
Fatores de Tempo
Limites: Humanos
Masculino
Feminino
Adulto
Pessoa de Meia-Idade
Idoso
Responsável: BR1.1 - BIREME


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Id: lil-778998
Autor: Pereira, Camila V; Tovo, Cristiane Valle; Grossmann, Thiago K; Mirenda, Henrique; Dal-Pupo, Bruna B; Almeida, Paulo RL de; Mattos, Angelo A de.
Título: Efficacy of entecavir and tenofovir in chronic hepatitis B under treatment in the public health system in southern Brazil
Fonte: Mem. Inst. Oswaldo Cruz;111(4):252-257, Apr. 2016. tab.
Idioma: en.
Resumo: There are about 350 million hepatitis B virus (HBV) carriers worldwide and chronic HBV is considered a major public health problem. The objective of the present study was to assess the effectiveness of the nucleos(t)ide analogues tenofovir (TDF) and entecavir (ETV) in the treatment of chronic HBV. A cross-sectional study was carried out from March-December 2013, including all patients with chronic HBV, over 18 years of age, undergoing therapy through the public health system in southern Brazil. Only the data relating to the first treatments performed with TDF or ETV were considered. Retreatment, co-infection, transplanted or immunosuppressed patients were excluded. Six hundred and forty patients were evaluated, of which 336 (52.5%) received TDF and 165 (25.8%) ETV. The other 139 (21.7%) used various combinations of nucleos(t)ide analogues and were excluded. The negativation of viral load was observed in 87.3% and 78.8% and the negativation of hepatitis B e antigen was achieved in 79% and 72% of those treated with ETV or TDF, respectively. Negativation of hepatitis B surface antigen was not observed. There was no occurrence of adverse effects. This is a real-life study demonstrating that long-term treatment with ETV and TDF is both safe and effective.
Descritores: Antivirais/uso terapêutico
Guanina/análogos & derivados
Hepatite B Crônica/tratamento farmacológico
Tenofovir/uso terapêutico
-Estudos Transversais
DNA Viral
Guanina/uso terapêutico
Antígenos E da Hepatite B/imunologia
Antígenos de Superfície da Hepatite B/imunologia
Vírus da Hepatite B/imunologia
Saúde Pública
Resultado do Tratamento
Carga Viral
Limites: Humanos
Masculino
Feminino
Pessoa de Meia-Idade
Responsável: BR1.1 - BIREME


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Id: lil-751886
Autor: Hua, Wenhao; Zhang, Guanbin; Guo, Shujun; Weijie, Li; Sun, Lanhua; Xiang, Guangxin.
Título: Microarray-based genotyping and detection of drug-resistant HBV mutations from 620 Chinese patients with chronic HBV infection
Fonte: Braz. j. infect. dis;19(3):291-295, May-Jun/2015. tab, graf.
Idioma: en.
Resumo: Background: Research has shown that hepatitis B virus (HBV) genotypes are closely linked to the clinical manifestations, treatment, and prognosis of the disease. Objective: To study the association between genotype and drug-resistant HBV mutations in 620 Chinese patients with chronic HBV infection. Methods: HBV DNA levels were determined using real-time quantitative PCR in plasma samples. Microarrays were performed for the simultaneous detection of HBV genotypes (HBV/B, C, and D) and drug-resistance-related hotspot mutations. A portion of the samples analyzed using microarrays was selected randomly and the data were confirmed using direct DNA sequencing. Results: Most samples were genotype C (471/620; 76.0%), followed by genotype B (149/620; 24.0%). Among the 620 patient samples, 17 (2.7%) had nucleotide analogs (NA) resistance-related mutations. Of these, nine and eight patients carried lamivudine (LAM)-/telbivudine (LdT)-resistance mutations (rtL180M, rtM204I/V) and adefovir (ADV)-resistance mutations (rtA181T/V, rtN236T), respectively. No patients had both lamivudine (LAM)- and either ade-fovir (ADV) or entecavir (ETV) resistance mutations. Additionally, out of the 620 patient samples, 64.0% (397/620) were also detected with the precore stop-codon mutation (G1896A) by microarray assay. Conclusion: The results of the current study revealed that the prevalence of nucleotide analogs (NA)-resistance in Chinese hospitalized HBV-positive patients was so low that intensive nucleotide analogs (NA)-resistance testing before nucleotide analog (NA) treatment might not be required. In addition, the present study suggests that chronic HBV patients with genotype C were infected with fitter viruses and had an increased prevalence of nucleotide analogs (NA)-resistance mutations compared to genotype B virus. .
Descritores: Antivirais/administração & dosagem
Farmacorresistência Viral/genética
Vírus da Hepatite B/genética
Hepatite B Crônica/virologia
Mutação
-Grupo com Ancestrais do Continente Asiático
Adenina/administração & dosagem
Adenina/análogos & derivados
DNA Viral/genética
Genótipo
Guanina/administração & dosagem
Guanina/análogos & derivados
Vírus da Hepatite B/efeitos dos fármacos
Hepatite B Crônica/tratamento farmacológico
Lamivudina/administração & dosagem
Análise em Microsséries
Organofosfonatos/administração & dosagem
Prognóstico
Análise de Sequência de DNA
Timidina/administração & dosagem
Timidina/análogos & derivados
Limites: Adulto
Feminino
Humanos
Masculino
Responsável: BR1.1 - BIREME


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Texto completo SciELO Saúde Pública
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Id: lil-733331
Autor: Muñoz, Nubia; Knaul, Felicia; Lazcano, Eduardo.
Título: 50 años del Registro Poblacional de Cáncer de Cali, Colombia / 50 years of the population-based Cancer Registry of Cali, Colombia
Fonte: Salud pública Méx;56(5):421-422, sep.-oct. 2014.
Idioma: es.
Descritores: Butadienos/metabolismo
-Adenina/metabolismo
DNA
Compostos de Epóxi/metabolismo
Globinas/metabolismo
Guanina/metabolismo
Guanosina/metabolismo
Especificidade da Espécie
Limites: Animais
Feminino
Humanos
Masculino
Camundongos
Ratos
Tipo de Publ: Research Support, Non-U.S. Gov't
Responsável: BR1.1 - BIREME


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Id: lil-732505
Autor: Oliveira, Cristiane.
Título: O discurso do excesso sexual como marca da brasilidade: revisitando o pensamento social brasileiro das décadas de 1920 e 1930 / The discourse of sexual excess as a hallmark of Brazilianness: revisiting Brazilian social thinking in the 1920s and 1930s
Fonte: Hist. ciênc. saúde-Manguinhos;21(4):1093-1112, Oct-Dec/2014.
Idioma: pt.
Resumo: O objetivo deste trabalho é analisar o discurso do excesso sexual produzido pelo pensamento social brasileiro das décadas de 1920 e 1930 na sua interlocução com o discurso médico da época. De inspiração foucaultiana, o texto inscreve-se no campo da história dos saberes e está subsidiado por documentos sociológicos e médicos do período de referência. No quadro da recodificação vintecentista sobre o imaginário da brasilidade, o tema do excesso sexual foi revisitado pelo pensamento sociológico local, forjando-o ora como um perturbador do projeto civilizatório nacional, ora como um traço que deveria ser positivado por ter sido a condição de possibilidade da hibridização cultural de suas matrizes identitárias.

The objective of this article is to analyze the discourse of sexual excess produced by Brazilian social thinking in the 1920s and 1930s and its dialog with the medical discourse at the time. Inspired by Foucault, it is within the field of the history of knowledge and is supported by sociology and medical documents from the period in question.Within the framework of the twentieth century re-codification of the imagery of Brazilianness, the topic of sexual excess was revisited by local thinkers in the field of sociology and seen either as disturbing the national civilizing project, or as a trait that should be seen in a positive light because it permitted the cultural hybridization of its sources of identity.
Descritores: Adenina/metabolismo
Adutos de DNA/metabolismo
Compostos de Epóxi/metabolismo
Guanina/metabolismo
Mutagênicos/metabolismo
-Adutos de DNA/química
Adutos de DNA/isolamento & purificação
Compostos de Epóxi/química
Compostos de Epóxi/isolamento & purificação
Guanosina/metabolismo
Mutagênicos/química
Mutagênicos/isolamento & purificação
Limites: Animais
Bovinos
Tipo de Publ: Research Support, Non-U.S. Gov't
Responsável: BR1.1 - BIREME


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Id: lil-730418
Autor: Tan, You-wen; Ge, Guo-hong; Sun, Li; Zhou, Xing-bei; Peng, Pen-li; Chen, Li.
Título: Efficacy of Entecavir therapy in elderly patients with chronic hepatitis B infection
Fonte: Braz. j. infect. dis;18(6):691-692, Nov-Dec/2014. tab.
Idioma: en.
Descritores: Antivirais/uso terapêutico
Guanina/análogos & derivados
Hepatite B Crônica/tratamento farmacológico
-Guanina/uso terapêutico
Estudos Retrospectivos
Resultado do Tratamento
Limites: Humanos
Pessoa de Meia-Idade
Tipo de Publ: Carta
Responsável: BR1.1 - BIREME


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Texto completo SciELO Saúde Pública
Cherchiglia, Mariângela Leal
Acúrcio, Francisco de Assis
Texto completo
Id: lil-695415
Autor: Oliveira, Gustavo Laine Araujo de; Almeida, Alessandra Maciel; Silva, Anderson Lourenco da; Brandao, Cristina Mariano Ruas; Andrade, Eli Iola Gurgel; Cherchiglia, Mariangela Leal; Acurcio, Francisco de Assis.
Título: Antivirais incorporados no Brasil para hepatite B cronica: analise de custo-efetividade / Antivirales incorporados en Brasil para hepatitis B cronica: analisis de costo-efectividad / Incorporated antivirals for chronic hepatitis B in Brazil: a cost-effectiveness analysis
Fonte: Rev. saúde pública = J. public health;47(4):769-780, ago. 2013. tab, graf.
Idioma: pt.
Projeto: Conselho Nacional de Desenvolvimento Cientifico e Tecnologico.
Resumo: OBJETIVO Avaliar o custo-efetividade de diferentes tratamentos medicamentosos para hepatite B crônica entre pacientes adultos. MÉTODOS Utilizando modelo de Markov, construiu-se coorte hipotética de 40 anos para pacientes HBeAg-positivo ou HBeAg-negativo. Foram comparados os usos de adefovir, entecavir, tenofovir e lamivudina (com terapia de resgate em caso de resistência viral) para tratamento de pacientes adultos com hepatite B crônica, virgens de tratamento, com elevados níveis de alanina aminotransferase, sem evidência de cirrose e sem coinfecção por HIV. Valores para custo e efeito foram obtidos da literatura. A medida do efeito foi expressa em anos de vida ganhos (AVG). Taxa de desconto de 5% foi aplicada. Análise de sensibilidade univariada foi conduzida para avaliar incertezas do modelo. RESULTADOS O tratamento inicial com entecavir ou tenofovir apresentou melhores resultados clínicos. As menores razões custo-efetividade foram de entecavir para pacientes HBeAg-positivo (R$ 4.010,84/AVG) e lamivudina para pacientes HBeAg-negativo (R$ 6.205,08/AVG). Para pacientes HBeAg-negativo, a razão custo-efetividade incremental de entecavir (R$ 14.101,05/AVG) está abaixo do limiar recomendado pela Organização Mundial da Saúde. Análise de sensibilidade mostrou que variação nos custos dos medicamentos pode tornar tenofovir alternativa custo-efetiva tanto para pacientes HBeAg-positivo quanto para HBeAg-negativo. CONCLUSÕES Entecavir é alternativa recomendada para iniciar o tratamento de pacientes com hepatite B crônica no Brasil. Contudo, se houver redução no custo de tenofovir, esta pode se tornar alternativa mais custo-efetiva. .

OBJETIVO Evaluar el costo-efectividad de diferentes tratamientos medicamentosos para hepatitis B crónica entre pacientes adultos. MÉTODOS Utilizando el modelo de Markov, se construyó cohorte hipotética de 40 años para pacientes HBeAg-positivo o HBeAg-negativo. Se compararon los usos de adefovir, entecavir, tenofovir y lamivudina (con terapia de rescate en caso de resistencia viral) para tratamiento de pacientes adultos con hepatitis B crónica, vírgenes de tratamiento, con elevados niveles de alanina aminotransferasa, sin evidencia de cirrosis y sin coinfección por VIH. Valores para costo y efecto fueron obtenidos de la literatura y efecto en años de vida ganados (AVG). Tasa de descuento de 5% fue aplicada. Análisis de sensibilidad univariado fue conducido para evaluar incertidumbres del modelo. RESULTADOS El tratamiento inicial con entecavir o tenofovir presentó mejores resultados clínicos. Los menores cocientes costo-efectividad fueron de entecavir para pacientes HBeAg-positivo (R.010,84/AVG) y lamivudina para pacientes HBeAg-negativo (R.205,08/AVG).Para pacientes HBeAg-negativo, el cociente costo-efectividad incrementado de entecavir (R.101,05/AVG) está por debajo del límite recomendado por la Organización Mundial de la Salud. El análisis de sensibilidad mostró que la variación en los costos de los medicamentos puede tornar tenofovir una alternativa costo-efectiva tanto para pacientes HBeAg-positivo como para los HBeAg-negativo. CONCLUSIONES Entecavir es una alternativa recomendada para iniciar el tratamiento de pacientes con hepatitis B crónica en Brasil. Sin embargo, al haber reducción en el costo de tenofovir, éste puede convertirse en una alternativa más costo-efectiva. .

OBJECTIVE To evaluate the cost-effectiveness of different drug therapies for chronic hepatitis B in adult patients. METHODS Using a Markov model, a hypothetical cohort of 40 years for HBeAg-positive or HBeAg-negative patients was constructed. Adefovir, entecavir, tenofovir and lamivudine (with rescue therapy in cases of viral resistance) were compared for treating adult patients with chronic hepatitis B undergoing treatment for the first time, with high levels of alanine aminotransferase, no evidence of cirrhosis and without HIV co-infection. Values for cost and effect were obtained from the literature, and expressed in effect on life years (LY). A discount rate of 5% was applied. Univariate sensitivity analysis was conducted to assess model uncertainties. RESULTS Initial treatment with entecavir or tenofovir showed better clinical outcomes. The lowest cost-effectiveness ratio was for entecavir in HBeAg-positive patients (R$ 4,010.84/LY) and lamivudine for HBeAg-negative patients (R$ 6,205.08/LY). For HBeAg-negative patients, the incremental cost-effectiveness ratio of entecavir (R$ 14,101.05/LY) is below the threshold recommended by the World Health Organization. Sensitivity analysis showed that variation in the cost of drugs may make tenofovir a cost-effective alternative for both HBeAg-positive and HBeAg-negative patients. CONCLUSIONS Entecavir is the recommended alternative to start treating patients with chronic hepatitis B in Brazil. However, if there is a reduction in the cost of tenofovir, it can become a cost-effective alternative. .
Descritores: Antivirais/economia
Hepatite B Crônica/tratamento farmacológico
-Análise de Variância
Adenina/análogos & derivados
Adenina/economia
Adenina/uso terapêutico
Antivirais/classificação
Antivirais/uso terapêutico
Brasil
Análise Custo-Benefício
Progressão da Doença
Guanina/análogos & derivados
Guanina/economia
Guanina/uso terapêutico
Vírus da Hepatite B
Lamivudina/economia
Lamivudina/uso terapêutico
Cadeias de Markov
Organofosfonatos/economia
Organofosfonatos/uso terapêutico
Resultado do Tratamento
Limites: Adulto
Humanos
Tipo de Publ: Research Support, Non-U.S. Gov't
Responsável: BR1.1 - BIREME



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