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( Sang Hoon Ahn ),( Won Hyeok Choe ),( Yoon Jun Kim ),( Jeong Heo ),( Dorota Latarska-smuga ),( Jiho Kang ),( Seung Woon Paik ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Chronic Hepatitis C Virus (HCV) infection increases the risk for progressive liver disease, hepatocellular carcinoma and negatively impacts the patient’s quality of life. HCV treatment is evolving with direct acting antivirals but IFN based therapy has been the standard of care for many years and remains available in some countries. The MOSAIC study aims to characterize patients with chronic HCV infection and assess the impact of IFN-containing treatment on health-related quality of life, work related productivity and health care utilization. Methods: MOSAIC is an international prospective multicenter observational study that has been conducted in 20 countries. Consecutive patients with chronic HCV infection were enrolled and those who initiated an IFN based regimen were prospectively followed for 48 weeks. We report results from the Korean cohort Results: 100 patients were enrolled: 86 were treatment naïve and 14 were treatment experienced. 33 patients initiated an IFN based regimen: 6 patients started IFN + RBV, 26 patients started Peg-IFN + RBV, none started Peg-IFN + RBV + DAA and 1 patient received other treatment. Among the treated cohort, demographic and disease characteristics were the following: the mean age was 54.5 years; 14 patients were male. 14 had minimal or no fibrosis, 2 portal fibrosis, 3 bridging fibrosis and 6 patients suffered from cirrhosis. HCV Genotype distribution was as follows: genotype 1: 11; genotype 2: 19 and genotype 3: 3. Table 1 describes the results at baseline and changes over 4, 12 and 48 weeks and end-of-treatment (EOT) for the quality of life and work productivity outcome measures (EQ-5D-5L, HCV-PRO and WPAI). Conclusions: Results from the Korean cohort of the MOSAIC study show a moderate trend for deterioration of health-related quality of life and work productivity associated with IFN based treatment for patients with chronic HCV infection during treatment period. Acknowledgements: The design, study conduct, analysis, and financial support of MOSAIC study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the content of the abstract. All authors had access to all relevant data and participated in writing, review, and approval of this abstract. Medical writing support was provided by Olivier Van de Steen of Medeor-consulting, funded by AbbVie. Disclosures: Sang Hoon Ahn: served as an advisor and lecturer for Bristol-Myers Squibb, Gilead Sciences, F.Hoffmann-La Roche, Merck, AbbVie, and has received unrestricted grants from Bristol-Myers Squibb, Gilead Sciences, and F. Hoffmann-La Roche for investigator- initiated trials Won Hyeok Choe: Nothing to disclosure Yoon Jun Kim: Nothing to disclosure Jeong Heo: received a grant from GSK; Research support from BMS, and Roche; Advisor for Abbvie, BMS, Gilead Sciences, Pharma Essentia, SillaJen, and Johnson & Johnson. Dorota Latarska-Smuga, Jiho Kang: are employees of AbbVie, Inc. and may hold stock or stock options. Seung Woon Paik: received grant and research support from AbbVie, BMS, Gilead, GSK, Merck, Novartis, and Roche
( Won Hyeok Choe ),( So Young Kwon ),( Byung-chul Yoo ),( Jeong Han Kim ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: Oral antiviral agents are main stay of chronic hepatitis B (CHB) treatment and most patients can achieve virological response (VR, undetectable HBV DNA). However, final end point is HBsAg loss and seroconversion. We aimed to evaluate HBsAg level change in CHB patients who achived VR with oral antiviral agents. Methods: This is a retrospective study and the treatment naive CHB patients who achived VR with oral antiviral agents in Konkuk university hospital more than 3 years were enrolled. HBsAg level change was analyzed with Friedman test. Results: Total 105 patients were included in this study. Median age was 51 years and 33 patients were male (31.4%). HBeAg positive patients were 60 (57.1%), cirrhosis patients were 45 (42.9%) and hepatocellular carcinoma patients were 15 (14.3%). Used agents were lamivudine (LMV) in 45 patients (42.9%), entecavir (ETV) in 45 patients (42.9%) and tenofovir (TDF) in 15 patients (14.3%). During 3 years teatment, HBsAg level was reduced from mean 3.24 (log10 IU/mL) to 3.11 (log10 IU/mL) significantly (p=0.005). In subanalysis according to HBeAg status and agents, only ETV treated patients showed significant HBsAg reduction (p=0.001). During 5 years treatment except TDF treated patients due to short duration, HBeAg negative (p<0.001), LMV treated (p=0.001), ETV treated (p=0.038) patients showed significant HBsAg reduction. Conclusions: Successful oral antiviral agents treatment can lead to HBsAg reduction in CHB patients. More powerful agent may reduce HBsAg more rapidly especially in HBeAg negative patients.
( Won Hyeok Choe ),( So Young Kwon ),( Jeong Hwan Kim ),( Byung Kook Kim ),( Chi Hoon Kim ),( Chang Hong Lee ) 대한소화기학회 2007 SIDDS Vol.9 No.-
Background/Aims: The optimal management of bleeding from gastroesophageal varices (GOV) remains controversial. The aim of this study was to investigate whether endoseopic variceal ligation (EVL) is effective and safe for the management of bleeding from GOV. Methods: Forty-one cirrhotic patients receiving EVL due to a history of variceal bleeding from GOV were analyzed. In twenty-two patients of them, serial endoseopic ultrasonography (EUS) were performed. GOV were grade using the system suggested by Sarin et al: type I (GOVI) and type 2 (GOV2). Results: Twenty-eight patients were GOVI and thirteen patients were GOV2. Successful treatment for controlling acute bleeding were achieved in 26/28 (93%) in GOVI and 9/13 (85%) in GOV2. Rebleeding was 15% in GOVI, while 40% in GOV2. Multivariate Cox regression indicated that type of GOV, variceal size and residual variceal size after EVL were independent factors predictive of GOV re-bleeding. Serial EUS findings demonstrated that the size of GOVI became decreased after EVL in 10/15 (67%) patients, while GOV2 did not change. Conclusions: EVL was safe and effective for the emergency treatment of acutely variceal bleedings from GOV. For the preventing variceal rebleeding, EVL was more effective in GOVI than GOV2.
Choe, Won Hyeok,Hong, Sun Pyo,Kim, Byung Kook,Ko, Soon Young,Jung, Young Kul,Kim, Ji Hoon,Yeon, Jong Eun,Byun, Kwan Soo,Kim, Kyun-Hwan,Ji, Seung Il,Kim, Soo-Ok,Lee, Chang Hong,Kwon, So Young International Medical Press 2009 ANTIVIRAL THERAPY Vol.14 No.7
<P>BACKGROUND: The efficacy of entecavir (ETV) monotherapy in treatment-experienced patients with chronic hepatitis B (CHB) is debatable. METHODS: A total of 22 hepatitis B e antigen (HBeAg)-positive CHB patients who had shown viral breakthrough or suboptimal response with lamivudine (3TC) and adefovir disoproxil (ADV) therapy were treated with 1.0 mg of ETV. Clinical and virological parameters were monitored every 3 months. Restriction fragment mass polymorphism assays were used to detect antiviral resistance. RESULTS: During 3TC and ADV therapy, 11 patients had rtM204V/I mutations, 2 had rtA181V/T or rtN236T, 7 had both and 2 had no 3TC- or ADV-related mutations. After switching to ETV monotherapy, the median change in serum hepatitis B virus (HBV) DNA level was -2.1 log(10) copies/ml. Virological response (HBV DNA<300 copies/ml) was achieved in 1 of 18 patients with pre-existing rt204 mutations, whereas it was achieved in all 4 patients without pre-existing rt204 mutations regardless of the presence of rt181 or rt236 mutations. Changes in mutational patterns during ETV therapy showed that rt204 mutations persisted or re-emerged. Relative abundances of rtM204V/I mutations in total viral populations gradually increased under ETV rescue, whereas those with rtA181V/T and rtN236T mutations decreased. ETV resistance mutations (rtL180M+rtT184I/L[rtS202G]+rtM204V) were detected in five patients with pre-existing rt204 mutations. CONCLUSIONS: ETV monotherapy resulted in a limited virological response in patients who had previously failed 3TC and ADV rescue therapy. The limited efficacy might be associated with residual or reselected rtM204V/I mutations leading to ETV resistance. Combination treatment including potent antiviral agents should be recommended for patients with pre-existing rtM204V/I mutations.</P>
최원혁 ( Won Hyeok Choe ) 대한간학회 2014 Postgraduate Courses (PG) Vol.2014 No.1
현재의 경구용 항바이러스는 바이러스 복제를 억제할 수 있지만, 바이러스를 완전히 소멸하는, 즉 혈청학적으로 HBsAg의 혈청 소실을 유도하고 임상적으로 소위 ``완치``에 해당하는 치료 목표를 달성하기는 현실적으로 불가능하며, 따라서 장기간의 치료가 불가피하다. 이러한 단점을 극복하고자 다각적으로 B형 간염을 소멸시키기 위한 새로운 치료법이 연구되고 있다. 이들 방법은 첫째, HBV의 생활사 과정 중 바이러스의 생존에 필수적인 단계를 직접 차단하거나 제거하는 방법이며, 두번째는 면역 치료를 통한 방법이 연구되고 있다. 이런 치료전략을 바탕으로 다양한 연구 및 치료제 개발이 진행되고 있다. 향후에는 HBV를 억제할 뿐 아니라 바이러스를 완전히 소멸하거나 제거하여 만성 B형간염을 ``완치`` 할 수 있는 새로운 지평이 열리기를 기대한다. Chronic infection of hepatitis B virus (HBV) is still the main cause of cirrhosis and hepatocellular carcinoma worldwide. In the past two decades, there have been major developments in the treatment of chronic hepatitis B. Pegylated interferon can be given conveniently with weekly dosing, and its effect on hepatitis B e antigen seroconversion is highly durable. However, it is poorly tolerated, and the treatment is successful in less than a half of patients. Oral nucleos(t)ide analogues such as tenofovir and entecavir are very potent agents, and they can effectively suppress HBV replication with minimal risk of antiviral resistance. However, many patients experience virologic flare-up after cessation of oral antiviral agents, despite prolonged viral suppression, and would require long-term treatment. Therefore, novel therapeutic strategies are necessary to achieve either elimination of the virus from the liver or durable immune control of HBV infection without continuous antiviral treatment. These therapeutic approaches can be divided into two main categories: (1) therapies targeting the HBV directly or through host factors required by virus, and (2) therapies targeting the host innate or adaptive immune responses to restore the antiviral host immunity. The clinical application of new potential therapeutic approaches would be expected to achieve a cure for chronic hepatitis B patients in the not too distant future.