What do you know about nucleoside drugs?

Nucleoside drugs are oral anti-HBV drugs. There are two kinds of nucleoside drugs: one is nucleoside and the other is nucleotide. Nucleosides include lamivudine, telbivudine and entecavir; The nucleotide is adefovir dipivoxil. But entecavir is not exactly the same as the two "Fuding", it is pyrimidine, and entecavir is purine. Department of Hepatology, Jingzhou Second People's Hospital Zhu Gangjian

Nucleoside drugs can also be divided into three categories according to their structures: ① L- nucleosides, such as lamivudine and telbivudine; It is pyrimidine 2.

Acyclic phosphate, adefovir dipivoxil and tenofovir; It is purine, ③ cyclopentane/

Olefins such as entecavir. At present, lamivudine, telbivudine, adefovir and entecavir are listed; Tenofovir will also be listed. Such new drugs are still under development, and better drugs will come out.

This kind of drugs also have the same characteristics. Its advantage is easy to use, just take one tablet every day. Strong safety, few adverse reactions and almost no contraindications; The most important thing is that it has a strong activity of inhibiting virus replication and can quickly improve the condition. The disadvantage of * * * is that you need to take medicine for a long time, and there may be a risk of rebound if you stop taking medicine at will; Unplanned and irregular drug use is prone to drug resistance variation.

1. What are the characteristics of lamivudine?

Lamivudine is the first oral antiviral drug developed, which has been on the market for 10 years, and has treated millions of people and countless patients, and gained rich experience.

Among the above oral antiviral drugs, the activity of lamivudine in inhibiting virus replication is at a medium level, which can be reduced to the fifth power of logarithm every year (that is, 1/65438+ million before treatment). With the decrease of virus level, the serum transaminase of 70% patients decreased to normal within 3 months. Self-conscious symptoms have also improved; Liver tissue lesions will make significant progress within 6 months. Patients with liver cirrhosis recover slowly.

Lamivudine is the safest and reasonably priced nucleoside drug. It is the most widely used antiviral drug in the past, present and recent years, and its monthly cost is about 460 yuan.

However, lamivudine is also the most prone to drug resistance variation, increasing at a rate of 20% every year. In the past, due to "outshining others" and some misleading, there were many HBV-infected people with drug resistance variation in China, which may lead to cross-resistance to other nucleoside drugs, resulting in difficulties in treatment. If you can learn a lesson and use it properly in the future, it is still a good medicine.

2. What are the characteristics of adefovir?

The inhibitory effect of adefovir on virus replication is slightly weak, and it decreases with the fourth power in 1 year, so the disease control is slow, and only half of patients have normal serum transaminase in 1 year. However, the drug resistance variation of adefovir is small. As long as the replication level of serum virus is maintained at a low level for a long time, it is possible to control the disease stably for a long time.

Adefovir is a new drug with independent intellectual property rights in China. At present, many domestic enterprises are producing it. Among many kinds of nucleoside drugs, the price is the lowest (about one month in 430 yuan), and the price is still decreasing. It can not only solve patients' problems, but also not add too much economic burden to patients.

However, it should be noted that elderly patients and liver transplant patients may have potential renal damage, so more tests should be done during medication.

3. What are the characteristics of Entecavir?

Among the marketed and unlisted drugs, entecavir has the strongest activity of inhibiting virus replication, which can be reduced to the seventh power of logarithm every year, almost 0/00 times of lamivudine/kloc-0, and about 1 year can be reduced to undetectable by most patients with high virus level. The early effect is more obvious, and it can be reduced to quadratic in the first two weeks, which is especially beneficial to the treatment of severe patients. It can be used to inhibit the recurrence of virus in liver transplant patients and can be used for a long time to prevent the rejection of transplanted liver caused by reinfection.

The incidence of entecavir resistance variation in patients who have never used nucleoside drugs is very low, and the curative effect of patients who have been resistant to lamivudine will be significantly reduced. The biggest problem is that the price is the most expensive, and it costs 1 100 won per month.

4. What are the characteristics of 4.Tibiff?

Telbivudine is a similar drug of lamivudine, and its antiviral effect is about 10 times that of lamivudine. It can reduce the serum virus level 6 times a year on average, and about 60% patients can't detect the virus. However, most of these data come from abroad. From the clinical efficacy, disease control, HBV-DNA negative conversion rate and mutation rate are slightly better than lamivudine, but there is no actual difference statistically. The monthly cost of Tibif is around 700 yuan, which is not included in the national medical insurance. When the effect of lamivudine is not good, telbivudine can be considered, but the drug resistance rate is not lower than 10% after one year.

How to use these drugs correctly?

Because it is very convenient and safe to take such drugs, some patients stop taking them at will just like taking painkillers or stomach medicines. Serum transaminase is elevated, and they will stop using it when it is normal. Such irregular medication is rarely without problems, and there have been many lessons before. Be sure to take the medicine according to the prescribed dosage under the guidance of a doctor, check it regularly, and deal with the problems in time when found.