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Manajemen HepatiTis b kronik. Poin Pembahasan: Pengobatan Hepatitis B Kronik Studi GLOBE Telbivudine VS Entecavir Konsep Roadmap.

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Presentasi berjudul: "Manajemen HepatiTis b kronik. Poin Pembahasan: Pengobatan Hepatitis B Kronik Studi GLOBE Telbivudine VS Entecavir Konsep Roadmap."— Transcript presentasi:

1 Manajemen HepatiTis b kronik

2 Poin Pembahasan: Pengobatan Hepatitis B Kronik Studi GLOBE Telbivudine VS Entecavir Konsep Roadmap

3 Pengobatan Hepatitis B Kronik

4 Tujuan Terapi Supresi replikasi HBV DNA Serokonversi HBeAg Normalisasi SGPT Mencegah dekompensasi hepatik Mengurangi dan mencegah progresivitas ke arah sirosis dan/atau kanker hati Memperpanjang survival Liaw YF, et al. Hepatol Int 2008;2:

5 Adapted from Liaw YF, et al. Hepatol Int 2008;2: * For APASL 2012 has not been published yet HBeAg-positive HBV DNA <20,000 IU/mL (<10 5 copies/mL) HBV DNA ≥20,000 IU/mL (≥10 5 copies/mL) ALT normal No treatment Monitor HBV DNA, HBeAg, ALT/3-6 months Waktu Terbaik untuk Memulai Terapi

6 Adapted from Liaw YF, et al. Hepatol Int 2008;2: * For APASL 2012 has not been published yet HBeAg-positive HBV DNA ≥20,000 IU/mL (≥10 5 copies/mL) ALT normalALT 1-2x ULNALT 2-5x ULNALT >5x ULN No treatment Monitor HBV DNA, HBeAg, ALT/3 months No treatment Monitor HBV DNA, HBeAg, ALT/1-3 months Liver biopsy if patients > 40 years Treat if moderate or greater inflammation or fibrosis on biopsy Treatment if persistent (3-6 months) or has concerns for hepatic decompensation Interferon- based therapy, entecavir, telbivudine, lamivudine, adefovir, are all first-line options Waktu Terbaik untuk Memulai Terapi

7 HBV DNA ≥20,000 IU/mL (≥10 5 copies/mL) Treatment if persistent (3-6 months) or has concerns for hepatic decompensation Interferon- based therapy, entecavir, telbivudine, lamivudine, adefovir, are all first-line options ALT 2-5x ULNALT >5x ULN Treatment indicated If HBV-DNA < 2x106 IU/ml, may choose to observe closely for 3 months for seroconversion if no concerns for hepatic decompensation Interferon- based therapy; entecavir, telbivudine or lamivudine recommended, particularly if there is concern for hepatic decompensation ResponseNon-Response Monitor HBV DNA, HBeAg, ALT/1-3 months post- therapy Consider other strategy (including liver Tx) * For APASL 2012 has not been published yet Adapted from Liaw YF, et al. Hepatol Int 2008;2: Waktu Terbaik untuk Memulai Terapi

8 Adapted from Liaw YF, et al. Hepatol Int 2008;2: * For APASL 2012 has not been published yet HBeAg-negative HBV DNA <2,000 IU/mL (<10 4 copies/mL) HBV DNA ≥2,000 IU/mL (≥10 5 copies/mL) ALT normal No treatment Monitor HBV DNA and ALT/6-12 months Waktu Terbaik untuk Memulai Terapi

9 Adapted from Liaw YF, et al. Hepatol Int 2008;2: * For APASL 2012 has not been published yet HBeAg-negative HBV DNA ≥2,000 IU/mL (≥10 4 copies/mL) ALT normalALT 1-2x ULNALT > 2x ULN No treatment Monitor HBV DNA and ALT/3 months No treatment Monitor HBV DNA and ALT/1-3 months Liver biopsy if patients > 40 years Treat if moderate or greater inflammation or fibrosis on biopsy Treatment if persistent (3-6 months) or has concerns for hepatic decompensation Interferon- based therapy, entecavir, telbivudine, lamivudine, adefovir, are all first-line options Waktu Terbaik untuk Memulai Terapi

10 HBV DNA ≥2,000 IU/mL (≥10 4 copies/mL) Treatment if persistent (3-6 months) or has concerns of hepatic decompensation IFN based-therapy, entecavir, adefovir, telbivudine, lamivudine, Long-term oral antiviral treatment usually required ALT > 2x ULN ResponseNon-Response Monitor HBV DNA, HBeAg, ALT/1-3 months post-therapy Continued monitoring to recognize delayed response or plan other strategy * For APASL 2012 has not been published yet Adapted from Liaw YF, et al. Hepatol Int 2008;2:

11 Waktu Terbaik untuk Menghentikan Terapi Untuk Antiviral Agen: –Pada pasien HBeAg-positif, terapi dapat dihentikan bila treatment serokonversi HBeAg dengan HBV DNA tidak terdeteksi telah terdokumentasi pada 2 pemeriksaan dengan selang waktu minimal 6 bulan –Pada pasien HBeAg-negatif, tidak jelas kapan terapi dapat dihentikan, tetapi penghentian terapi dapat dipertimbangkan bila HBV-DNA tidak terdeteksi telah terdokumentasi pada 3 pemeriksaan dengan selang waktu minimal 6 bulan Liaw YF, et al. Hepatol Int 2008;2: * For APASL 2012 has not been published yet

12 Terapi Hepatitis B Kronik 1. Lin KW, et al. Am Fam Physician 2004;69: Available at: 3. MIMS.com Pilihan terapi di Indonesia: 1.IFN 2. Antiviral NA 1.Peg alfa – 2b 1. Lamivudine 2.Peg alfa – 2a 2. Adefovir 3.IFN alfa – 2b 3. Entecavir 4. Telbivudine Note: tahun berdasarkan approval oleh FDA Interferon alfa-2b Lamivudine Adefovir Peginterferon alfa-2a Telbivudine Tenofovir Entecavir

13 TERIMA KASIH THANK YOU


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