Pegylated interferon in the treatment of HBeAg-positive chronic hepatitis B

Pegylated interferon in the treatment of HBeAg-positive chronic hepatitis B.  Hepatol Int: Evaluation of the efficacy of peginterferon sequential nucleoside analogs in the treatment of HBeAg-positive chronic hepatitis B patients.

Compared with standard peginterferon treatment, peginterferon sequential nucleoside analog therapy can achieve a more significant reduction in HBsAg levels and a higher ratio of HBsAg≤100 IU/mL.

At present, there are three possible options for optimizing antiviral treatment strategies for chronic hepatitis B:

(1) Initiation of combination therapy with pegylated interferon and nucleoside analogues;

(2) Sequential peginterferon therapy with nucleoside analogues;

(3) Pegylated interferon sequential nucleoside analog therapy.

There have been many research evaluations for scheme 1 and scheme 2, but the efficacy of scheme 3 is still lack of clinical research evaluation. This study aims to evaluate the efficacy of peginterferon sequential nucleoside analogs in the treatment of HBeAg-positive chronic hepatitis B patients.

Prospectively enrolled 132 patients with chronic hepatitis B. Among them, 65 patients received standard peginterferon treatment, and 67 patients were treated with peginterferon for 12 to 24 weeks, according to whether an early virological response was achieved, and whether to add nucleoside analogues to optimize treatment was decided. The main endpoints of the study were the decline in HBsAg at 24 weeks after the end of treatment and the rate of patients with HBsAg ≤ 100 IU/mL. The secondary evaluation endpoints were HBV DNA negative conversion rate, ALT return rate, HBeAg seroconversion rate, HBsAg clearance rate, and HBsAg seroconversion rate.

After 24 weeks of treatment, compared with the peginterferon standard group, the peginterferon sequential nucleoside analog optimized treatment group can achieve a more significant reduction in HBsAg level (−1.35 vs 0.67 log10 IU/mL, P=0.016), higher HBsAg ≤ 100 IU/mL ratio (32.8% vs 9.2%, P=0.001), higher HBV DNA negative conversion rate (79.1% vs 49.2%, P<0.001) and higher The ALT return to normal rate (80.6% vs 38.5%, P<0.001). Two groups of HBeAg seroconversion rate (35.8% vs 27.7%, P=0.316), HBsAg clearance rate (8.9% vs 4.6%, P=0.323), HBsAg seroconversion rate (4.5% vs 1.5%, P=0.325) There was no statistical difference.

Studies have shown that compared with standard peginterferon treatment, peginterferon sequential nucleoside analog therapy can achieve a more significant reduction in HBsAg levels and a higher ratio of HBsAg≤100 IU/mL.

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