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review : A 2015 roadmap for the management of hepatitis C virus infections in Asia
( Seng Gee Lim ),( Yock Young Dan ) 대한내과학회 2015 The Korean Journal of Internal Medicine Vol.30 No.4
The prevalence of hepatitis C virus (HCV) in Asia is 0.5% to 4.7%, with three different genotypes predominating, depending on the geographic region: genotype 1b in East Asia, genotype 3 in South and Southeast Asia, and genotype 6 inIndochina. Official approval for direct-acting antiviral agents (DAAs) in Asia lags significantly behind that in the West, such that in most countries the mainstay of therapy is still pegylated interferon and ribavirin (PR). Because the interleukin-28B genetic variant, associated with a high sustained virologic response (SVR), is common in Asians, this treatment is still acceptable in Asian patients with HCV infections. A roadmap for HCV therapy that starts with PR and takes into account those DAAs already approved in some Asian countries can provideguidance as to the best strategies for management, particularly of genotype 1 and 3 infections, based on SVR rates. Sofosbuvir and PR are likely to be the initial therapies for genotype 1 and 3 disease, although in the former these drugs may be suboptimal in patients with cirrhosis (62% SVR) and the extension of treatment to 24 weeks may be required. For difficult to treat genotype 3 infections in treatment-experienced patients with cirrhosis, a combination of sofosbuvir and PR result in an 83% SVR and is, therefore, currently the optimal treatment regimen. Treatment failure is best avoided since data on rescue therapies for DAA failure are still incomplete.
( Ki Tae Yoon ),( Seto Wai-kay ),( Kao Jia-horng ),( Lim Seng-gee ),( Peng Cheng-yuan ),( Kwan Soo Byun ),( Inokuma Tetsuro ),( June Sung Lee ),( Flaherty John ),( Yee Leland J ),( Jump Belinda ),( Se 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Background: Tenofovir alafenamide (TAF) has shown similar efficacy to tenofovir disoproxil fumarate (TDF) with better bone and renal safety in 2 Phase 3 trials through 96 weeks. After a protocol amendment, some TDF patients received 96 weeks while others received 144 weeks of TDF treatment before rolling over to open-label (OL) TAF. Aim: To examine whether duration of prior TDF treatment impacted changes in bone and renal parameters after 48 weeks of OL TAF treatment in the subset of East Asian (EA) patients with chronic HBV. Methods: Among 190 EAs randomized to TDF, changes in bone mineral density (BMD) by DXA scans and renal parameters were assessed from OL baseline to Week 48 following switch to OL TAF. Results: At Week 48, mean (SD) percent changes from OL baseline in hip-BMD were +0.92 (2.32) and +0.79 (2.47) and in spine-BMD were +1.52 (2.68) and +2.27 (3.51) for DB-TDF-144wks and DB-TDF-96wks, respectively. Similarly, median (Q1, Q3) changes from OL baseline in creatinine clearance (eGFR<sub>CG</sub>) were +2.4 (-4.2, +10.8) and +3.0 (-3.0, +8.4) mL/min for DB-TDF-144wks and DBTDF-96wks, respectively. Similar trends in BMD and eGFR<sub>CG</sub> changes were seen in non-EAs. Following switching to OL TAF, improvements in bone and renal biomarkers were also observed. Conclusions: In EA patients who switched to TAF from TDF, improvements were seen in bone and renal parameters.
Drug induced liver injury: East versus West – a systematic review and meta-analysis
En Xian Sarah Low,Qishi Zheng,Edwin Chan,Seng Gee Lim 대한간학회 2020 Clinical and Molecular Hepatology(대한간학회지) Vol.26 No.2
Drug induced liver injury (DILI) may be different in the East compared to the West due to differing disease prevalence, prescribing patterns and pharmacogenetic profiles. To review existing literature on causative agents of DILI in the East compared to the West, a comprehensive literature search was performed on electronic databases: MEDLINE/PubMed, Embase, Cochrane Library and China National Knowledge Infrastructure without language restrictions. Studies which involve patients having DILI and reported the frequency of causative agents were included. A random effects model was applied to synthesize the current evidence using prevalence of class-specific and agent-specific causative drugs with 95% confidence intervals. Of 6,914 articles found, 12 showed the distribution of drugs implicated in DILI in the East with a total of 33,294 patients and 16 in the West with a total of 26,069 DILI cases. In the East, the most common agents by class were anti-tuberculosis drugs (26.6%), herbal and alternative medications (25.3%), and antibiotics (15.7%), while in the West, antibiotics (34.9%), cardiovascular agents (17.3%), and non-steroidal anti-inflammatory drugs (12.5%) were the commonest. For individual agents, the most common agents in the East were isoniazid-rifampicin-pyrazinamide (25.4%), phenytoin (3.5%), and cephalosporin (2.9%) while in the West, amoxicillin-potassium clavulanate combination acid (11.3%), nimesulide (6.3%), and ibuprofen (6.1%) were the commonest. There was significant heterogeneity due to variability in single-centre compared to multi-centre studies. Differences in DILI in the East versus the West both in drug classes and individual agents are important for clinicians to recognize.
( Tiffany P. Hennedige ),( Gang Wang ),( Fiona P. Leung ),( Hind S. Alsaif ),( Lynette Ls Teo ),( Seng Gee Lim ),( Aileen Wee ),( Sudhakar K. Venkatesh ) 대한간학회 2017 Gut and Liver Vol.11 No.3
Background/Aims: Comparison of the accuracy of magnetic resonance elastography (MRE) and diffusion weighted imaging (DWI) for the diagnosis of liver fibrosis in patients with chronic hepatitis B (CHB). Methods: In this retrospective analysis, we investigated 63 patients with CHB and liver fibrosis. DWI was performed with both breath-hold (DWIBH) and free-breathing (DWI-FB) sequences (b=0, 500). The mean liver stiffness and apparent diffusion coefficient (ADC) were calculated by drawing regions of interest maps. Fibrosis staging according to the METAVIR system was independently performed by an experienced pathologist. A receiver operating curve (ROC) analysis was conducted to determine the accuracy of MRE, DWI-BH and DWI-FB in the detection and stratification of liver fibrosis. The performance of the detection of significant fibrosis (≥F2), advanced fibrosis (≥F3), and cirrhosis (F4) was also evaluated by comparing areas under the ROC. Results: There was a moderate and significantly negative correlation between the ADC values and liver stiffness. The accuracies for the detection of ≥F2/≥F3/F4 stage fibrosis with DWI-FB, DWI-BH and MRE were 0.84/0.76/0.72, 0.72/0.83/0.79 and 0.99/0.99/0.98, respectively. The performance of MRE was significantly better than DWI-FB and DWI-BH. There were no significant differences between the performance of DWI-FB and DWI-BH. Conclusions: MRE is more accurate than DWI for the detection and stratification of liver fibrosis in CHB. (Gut Liver 2017;11:401-408)