Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Sunday, 12 / 16 / 2018

Articles

HBsAg Loss with Peg-interferon Alfa-2a in Hepatitis B Patients with Partial Response to Nucleos(t)ide Analog: New Switch Study

ORIGINAL ARTICLE

HBsAg Loss with Peg-interferon Alfa-2a in Hepatitis B Patients with Partial Response to Nucleos(t)ide Analog: New Switch Study

Peng Hu#,1, Jia Shang#,2, Wenhong Zhang#,3, Guozhong Gong4, Yongguo Li5, Xinyue Chen6, Jianning Jiang7, Qing Xie8, Xiaoguang Dou9, Yongtao Sun10, Yufang Li11, Yingxia Liu12, Guozhen Liu13, Dewen Mao14, Xiaoling Chi15, Hong Tang16, Xiaoou Li17, Yao Xie18, Xiaoping Chen19, Jiaji Jiang20, Ping Zhao21, Jinlin Hou22, Zhiliang Gao23, Huimin Fan24, Jiguang Ding25, Dazhi Zhang1 and Hong Ren*,1

1Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
2Department of Infectious Diseases, Henan Provincial People’s Hospital, Zhengzhou, China
3Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
4Department of Infectious Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
5Department of Infectious Diseases, The First Affiliated Hospital of Harbin Medical University, Harbin, China
6International Medical Department, Beijing YouAn Hospital, Capital Medical University, Beijing, China
7Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
8Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
9Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang, China
10Department of Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
11Department of Infectious Diseases, General Hospital of Ningxia Medical University, Yinchuan, China
12Department of Infectious Diseases, Shenzhen Third People’s Hospital, Shenzhen, China
13Department of Infectious Diseases, Xiangya Hospital Central South University, Changsha, China
14Liver Disease Department, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
15Liver Disease Department, Guangdong Hospital of Traditional Chinese Medicine, Guangzhou, China
16Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
17Liver Disease Department, The Sixth People’s Hospital of Hangzhou, Zhejiang, China
18Liver Disease Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China
19Department of Infectious Diseases, Guangdong General Hospital, Guangzhou, China
20Center of Liver Diseases, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
21International Center for Liver Disease Treatment, 302 Hospital of PLA, Beijing, China
22Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
23Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
24Hepatology Unit, Guangzhou Eighth People’s Hospital, Guangzhou, China
25Hepatology Unit, Ruian People’s Hospital, Zhejiang, China
#These authors contributed equally to this study.

*Correspondence to: Hong Ren, Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China. Tel: +86-23-63693029, Fax: +86-23-63711527, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2018;6(1):25-34 DOI: 10.14218/JCTH.2017.00072
Received: November 5, 2017 Accepted: March 1, 2018 Published online: March 17, 2018

Abstract

Background and Aims: Hepatitis B surface antigen (HBsAg) loss is seldom achieved with nucleos(t)ide analog (NA) therapy in chronic hepatitis B patients but may be enhanced by switching to finite pegylated-interferon (Peg-IFN) alfa-2a. We assessed HBsAg loss with 48- and 96-week Peg-IFN alfa-2a in chronic hepatitis B patients with partial response to a previous NA.

Methods: Hepatitis B e antigen (HBeAg)-positive patients who achieved HBeAg loss and hepatitis B virus DNA <200 IU/mL with previous adefovir, lamivudine or entecavir treatment were randomized 1:1 to receive Peg-IFN alfa-2a for 48 (n = 153) or 96 weeks (n = 150). The primary endpoint of this study was HBsAg loss at end of treatment. The ClinicalTrials.gov identifier is NCT01464281.

Results: At the end of 48 and 96 weeks’ treatment, 14.4% (22/153) and 20.7% (31/150) of patients, respectively, who switched from NA to Peg-IFN alfa-2a cleared HBsAg. Rates were similar irrespective of prior NA or baseline HBeAg seroconversion. Among those who cleared HBsAg by the end of 48 and 96 weeks’ treatment, 77.8% (14/18) and 71.4% (20/28), respectively, sustained HBsAg loss for a further 48 weeks. Baseline HBsAg <1500 IU/mL and week 24 HBsAg <200 IU/mL were associated with the highest rates of HBsAg loss at the end of both 48- and 96-week treatment (51.4% and 58.7%, respectively). Importantly, extending treatment from 48 to 96 weeks enabled 48.3% (14/29) more patients to achieve HBsAg loss.

Conclusions: Patients on long-term NA who are unlikely to meet therapeutic goals can achieve high rates of HBsAg loss by switching to Peg-IFN alfa-2a. HBsAg loss rates may be improved for some patients by extending treatment from 48 to 96 weeks, although the differences in our study cohort were not statistically significant. Baseline and on-treatment HBsAg may predict HBsAg loss with Peg-IFN alfa-2a.

Keywords
Antiviral therapy, Peg-interferon, Nucleos(t)ide treated, Chronic hepatitis B

 

 

Journal of Clinical and Translational Hepatology 2018 vol. 6, 25-34  [ Html ] [ PDF Full-text ]

© The Authors 2018. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

 

 

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