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Beijing, China

Cao Z.H.,Beijing Youan Hospital
Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology | Year: 2012

To investigate the therapeutic efficacy of interferon (IFN) therapy and risk of long-term administration for chronic hepatitis C (CHC) patients who cannot tolerate the standard treatment. Forty-six CHC patients who had proven intolerant to standard treatments were treated with low-dose IFN (non-pegylated IFN: 60 to 300MIU QOD, or pegylated IFN: 50 to 90 mug/w) plus ribavirin (RBV; 0.6g to 0.9 g/d) for 72 weeks. Forty-three (93.5%) of the patients were able to tolerate the long-term treatment with low-dose IFN plus RBV. Only three patients experienced severe side effects (low white blood cell and platelet counts) that required treatment withdrawal. The virology response rates over treatment time were: rapid virologic response (RVR): 10.9%; early virus response (EVR): 30.4%; 24 week virologic response: 45.7%; and, 48 week virologic response: 47.8%. B-sonographic imaging revealed that three patients experienced improved liver morphology through the treatment course. The patients who achieved RVR, EVR, or 24 weeks virologic response also attained higher 48 week virologic response. The 24 week virologic response had the strongest predictive value of good prognosis. Our study demonstrated that long-term treatment with low-dose interferon plus ribavirin is effective for patients who are otherwise intolerant to standard treatment. In these patients, low-dose IFN plus RBV can obtain a high virologic response rate at 48 week. Furthermore, the 24 week virologic response is sufficiently predictive of treatment success. As with any treatment regimen, it is important for healthcare workers to monitor the disease status and potential side effects throughout the course of therapy. Source

Cohen C.J.,Community Research Initiative of New England | Andrade-Villanueva J.,University of Guadalajara | Clotet B.,Autonomous University of Barcelona | Fourie J.,Dr urie Medical Center | And 8 more authors.
The Lancet | Year: 2011

Background The non-nucleoside reverse transcriptase inhibitor (NNRTI), rilpivirine (TMC278; Tibotec Pharmaceuticals, County Cork, Ireland), had equivalent sustained efficacy to efavirenz in a phase 2b trial in treatment-naive patients infected with HIV-1, but fewer adverse events. We aimed to assess non-inferiority of rilpivirine to efavirenz in a phase 3 trial with common background nucleoside or nucleotide reverse transcriptase inhibitors (N[t]RTIs). Methods We undertook a 96-week, phase 3, randomised, double-blind, double-dummy, non-inferiority trial in 98 hospitals or medical centres in 21 countries. We enrolled adults (≥18 years) not previously given antiretroviral therapy and with a screening plasma viral load of 5000 copies per mL or more and viral sensitivity to background N(t)RTIs. We randomly allocated patients (1:1) using a computer-generated interactive web-response system to receive oral rilpivirine 25 mg once daily or efavirenz 600 mg once daily; all patients received an investigator-selected regimen of background N(t)RTIs (tenofovir-disoproxil-fumarate plus emtricitabine, zidovudine plus lamivudine, or abacavir plus lamivudine). The primary outcome was non-inferiority (12 margin on logistic regression analysis) at 48 weeks in terms of confirmed response (viral load <50 copies per mL, defined by the intent-to-treat time to loss of virologic response [TLOVR] algorithm) in all patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT00543725. Findings From May 22, 2008, we screened 947 patients and enrolled 340 to each group. 86 of patients (291 of 340) who received at least one dose of rilpivirine responded, compared with 82 of patients (276 of 338) who received at least one dose of efavirenz (difference 3·5 [95 CI -1·7 to 8·8]; pnon-inferiority<0·0001). Increases in CD4 cell counts were much the same between groups. 7 of patients (24 of 340) receiving rilpivirine had a virological failure compared with 5 of patients (18 of 338) receiving efavirenz. 4 of patients (15) in the rilpivirine group and 7 (25) in the efavirenz group discontinued treatment due to adverse events. Grade 2-4 treatment-related adverse events were less common with rilpivirine (16 [54 patients]) than they were with efavirenz (31 [104]; p<0·0001), as were rash and dizziness (p<0·0001 for both) and increases in lipid levels were significantly lower with rilpivirine than they were with efavirenz (p<0·0001). Interpretation Despite a slightly increased incidence of virological failures, a favourable safety profile and non-inferior efficacy compared with efavirenz means that rilpivirine could be a new treatment option for treatment-naive patients infected with HIV-1. Funding Tibotec. © 2011 Elsevier Ltd. Source

Sun J.,Southern Medical University | Xie Q.,Ruijin Hospital | Tan D.,Central South University | Ning Q.,Huazhong University of Science and Technology | And 23 more authors.
Hepatology | Year: 2014

An optimization strategy based on the Roadmap concept is supposed to improve the clinical outcomes of patients with suboptimal antiviral response. The aim of this study was to prove the concept with a multicenter, open-label, randomized, controlled study. In all, 606 hepatitis B e antigen (HBeAg)-positive, nucleos(t)ide-naive chronic hepatitis B patients were randomized to the Optimize or Mono group. Patients in the Optimize group were treated with telbivudine for 24 weeks, after which those suboptimal responders with HBV DNA ≥300 copies/mL at week 24 received telbivudine plus adefovir until week 104, while the early virological responders continued telbivudine monotherapy. Patients in the Mono group received telbivudine monotherapy. All patients with telbivudine monotherapy had adefovir added if viral breakthrough developed. Sixty-eight percent (204/300) of patients in the Optimize group had adefovir added due to suboptimal response. At week 104, compared to the Mono group, more patients in the Optimize group achieved HBV DNA <300 copies/ml (76.7% versus 61.2%, P<0.001) with less genotypic resistance (2.7% versus 25.8%, P<0.001). The rates of HBeAg seroconversion and alanine aminotransferase (ALT) normalization were comparable between the two groups (23.7% versus 22.1%; 80.7% versus 79.2%). For week 24 suboptimal responders, telbivudine plus adefovir showed an additive antiviral potency, with 71.1% achieving virological response at week 104 and only 0.5% developing genotypic resistance, compared with 46.6% who achieved virological response and 37.8% who developed genotypic resistance with telbivudine monotherapy. Both treatment regimens were well tolerated, with an observed persistent increase of the glomerular filtration rate. Conclusion: For suboptimal virological responders to telbivudine at week 24, adjusting the treatment strategy is recommended. Adding adefovir can benefit these patients with additive antiviral potency and low resistance without increased side effects. © 2014 by the American Association for the Study of Liver Diseases. Source

Liu K.,Peking University | Ying Z.,Dalian Medical University | Qi X.,Dalian Medical University | Shi Y.,Beijing Youan Hospital | Tang Q.,Peking University
International Journal of Molecular Medicine | Year: 2015

The aim of this study was to investigate the role of microRNAs (miRNAs or miRs) in vascular smooth muscle cell (VSMC) proliferation and to elucidate the underlying molecular mechanisms. In a previous study, using microarray analysis, differentially expressed miRNAs were identified in primary VSMCs isolated from the medial layer of the thoracic aorta obtained from spontaneously hypertensive rats (SHRs) and Wistar Kyoto (WKY) rats. Among others, miR-1 was identified to be downregulated in VSMCs from SHRs. Thus, in the present study, we focused on miR-1, the downregulation of which was confirmed by RT-qPCR and western blot analysis in VSMCs isolated from SHRs. We identified insulin-like growth factor 1 (IGF1) as a potential target gene of miR-1, and we subsequently validated IGF1 as a target gene of miR-1 by luciferase assay. The results revealed that the exogenous overexpression of miR-1 significantly suppressed the expression of IGF1. Additionally, we demonstrated that the downregulation of IGF1 by the introduction of miR-1 attenuated the proliferation of the VSMCs, suggesting that IGF1 is a target gene of miR-1 and that the effects of miR-1 are mediated through IGF1. In conclusion, the findings of our study demonstrate that miR-1 is significantly downregulated in VSMCs and that it is an important regulator of cell proliferation. Therefore, IGF1 may be involved in the regulation of VSMC proliferation by targeting miR-1. Source

Cohen C.J.,Community Research Initiative of New England | Molina J.-M.,University Paris - Sud | Cahn P.,Hospital Juan A Fernandez and Fundacion Huesped | Clotet B.,Hospital Universitari Germans Trias i Pujol | And 11 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2012

Background: Pooled analysis of phase 3, double-blind, doubledummy ECHO and THRIVE trials comparing rilpivirine (TMC278) and efavirenz. Methods: Treatment-naive HIV-1-infected adults were randomized 1:1 to rilpivirine 25 mg once daily or efavirenz 600 mg once daily, with background tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) (ECHO) or TDF/FTC, zidovudine/lamivudine, or abacavir/lamivudine (THRIVE). The primary endpoint was confirmed response [viral load <50 copies per milliliter; intent-to-treat time-to-loss-ofvirologic- response (ITT-TLOVR) algorithm] at week 48. The pooled data set enabled analyses of subgroups and predictors of response/virologic failure. Results: Confirmed responses were 84% (rilpivirine) and 82% (efavirenz). The difference in response rates (95% confidence interval) was 2.0% (-2.0% to 6.0%). The incidence of virologic failure was 9% (rilpivirine) versus 5% (efavirenz). Responses in ITT-TLOVR and ITT-snapshot analyses were consistent. Responses were similar for rilpivirine and efavirenz by background regimen, gender, race and clade. Suboptimal adherence and higher baseline viral load resulted in lower responses, higher virologic failure, and development of resistance in both groups; the effects on virologic failure were more apparent with rilpivirine. CD4 + cell count increased over time in both groups. Rilpivirine compared with efavirenz gave smaller incidences of adverse events leading to discontinuation (3% vs. 8%, respectively), treatment-related grade 2-4 adverse events (16% vs. 31%), rash (3% vs. 14%), dizziness (8% vs. 26%), abnormal dreams/nightmares (8% vs. 13%), and grade 2-4 lipid abnormalities. Conclusions: At week 48, rilpivirine 25 mg once daily and efavirenz 600 mg once daily had comparable response rates. Rilpivirine had more virologic failures and improved tolerability versus efavirenz. Copyright © 2012 by Lippincott Williams & Wilkins. Source

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