tailieunhanh - Chronic Viral Hepatitis - part 5

Điều trị IFN-α có liên quan với một loạt các tác dụng phụ ảnh hưởng đến hệ thống cơ thể khác nhau (Bảng 3). Trong số này, rối loạn cảm xúc là đáng lo ngại nhất, bởi vì rất khó phát hiện. Một phân tích meta-chín thử nghiệm ngẫu nhiên | 128 Teo and Lok Table 3 Adverse Effects Associated with IFN Treatment Flu-like symptoms Fatigue Anorexia and weight loss Depression and irritability Leucopenia and thrombocytopenia Alopecia and skin rash Induce or aggravate autoimmune disease Adverse Effects IFN-a therapy is associated with a range of side effects affecting various body systems Table 3 . Of these emotional lability is the most worrisome because it is difficult to detect. A meta-analysis of nine randomized controlled trials with 552 patients 18 showed that 35 of the patients treated with IFN required dose reduction and 5 required premature cessation of treatment. These figures were obtained within stringent clinical trials. Dose reductions and premature termination of treatment are probably more frequent in clinical practice. Prednisone Priming Prednisone can enhance HBV replication indirectly by suppressing the immune system or directly by interacting with the glucocorticoidresponsive element in the HBV genome. The rationale for glucocorticoid pretreatment stems from the observation that some patients with chronic hepatitis B cleared markers of HBV replication following tapering or discontinuing of steroid therapy 19 20 . These findings suggest that recovery of immune function following steroid withdrawal may be beneficial particularly if this is timed with the initiation of IFN-a therapy. Several studies failed to demonstrate an overall benefit of prednisone priming although patients with lower pretreatment ALT levels appeared to have a marginal benefit 16 . A meta-analysis of seven published studies directly comparing IFN-a with and without prednisone priming failed to show a significant increase in efficacy of IFN-a when steroid pretreatment was added 21 Table 4 . However a recent European multicenter study 22 involving 213 patients found that priming with relatively low doses of prednisone for 4 wk followed by a treatment-free period for 2 wk increased loss of HBeAg from 28 to 44 P . Thus