Manajemen HepatiTis b kronik

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

Pengobatan Hepatitis B Kronik

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;2:263-283

Waktu Terbaik untuk Memulai Terapi HBeAg-positive HBV DNA <20,000 IU/mL (<105 copies/mL) HBV DNA ≥20,000 IU/mL (≥105 copies/mL) ALT normal No treatment Monitor HBV DNA, HBeAg, ALT/3-6 months * For APASL 2012 has not been published yet Adapted from Liaw YF, et al. Hepatol Int 2008;2:263-283

Waktu Terbaik untuk Memulai Terapi HBeAg-positive HBV DNA ≥20,000 IU/mL (≥105 copies/mL) ALT normal ALT 1-2x ULN ALT 2-5x ULN ALT >5x ULN No treatment Monitor HBV DNA, HBeAg, ALT/3 months No treatment Monitor HBV DNA, HBeAg, ALT/1-3 months Treatment if persistent (3-6 months) or has concerns for hepatic decompensation Interferon- based therapy, entecavir, telbivudine, lamivudine, adefovir, are all first-line options Liver biopsy if patients > 40 years Treat if moderate or greater inflammation or fibrosis on biopsy * For APASL 2012 has not been published yet Adapted from Liaw YF, et al. Hepatol Int 2008;2:263-283

Waktu Terbaik untuk Memulai Terapi HBV DNA ≥20,000 IU/mL (≥105 copies/mL) ALT 2-5x ULN ALT >5x ULN Treatment if persistent (3-6 months) or has concerns for hepatic decompensation Interferon- based therapy, entecavir, telbivudine, lamivudine, adefovir, are all first-line options 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 Response Non-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;2:263-283

Waktu Terbaik untuk Memulai Terapi HBeAg-negative HBV DNA <2,000 IU/mL (<104 copies/mL) HBV DNA ≥2,000 IU/mL (≥105 copies/mL) ALT normal No treatment Monitor HBV DNA and ALT/6-12 months * For APASL 2012 has not been published yet Adapted from Liaw YF, et al. Hepatol Int 2008;2:263-283

Waktu Terbaik untuk Memulai Terapi HBeAg-negative HBV DNA ≥2,000 IU/mL (≥104 copies/mL) ALT normal ALT 1-2x ULN ALT > 2x ULN No treatment Monitor HBV DNA and ALT/3 months No treatment Monitor HBV DNA and ALT/1-3 months Treatment if persistent (3-6 months) or has concerns for hepatic decompensation Interferon- based therapy, entecavir, telbivudine, lamivudine, adefovir, are all first-line options Liver biopsy if patients > 40 years Treat if moderate or greater inflammation or fibrosis on biopsy * For APASL 2012 has not been published yet Adapted from Liaw YF, et al. Hepatol Int 2008;2:263-283

Waktu Terbaik untuk Memulai Terapi HBV DNA ≥2,000 IU/mL (≥104 copies/mL) ALT > 2x ULN 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 Response Non-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;2:263-283

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 * For APASL 2012 has not been published yet Liaw YF, et al. Hepatol Int 2008;2:263-283

Terapi Hepatitis B Kronik Interferon alfa-2b Lamivudine Adefovir Peginterferon alfa-2a Telbivudine Tenofovir 1992 1998 2002 2005 2006 2008 Entecavir Pilihan terapi di Indonesia: IFN 2. Antiviral NA Peg alfa – 2b 1. Lamivudine Peg alfa – 2a 2. Adefovir IFN alfa – 2b 3. Entecavir 4. Telbivudine Note: tahun berdasarkan approval oleh FDA 1. Lin KW, et al. Am Fam Physician 2004;69:75-82. 2. Available at: http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm 3. MIMS.com

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