Adding pegylated interferon to a current nucleos(t)ide therapy leads to HBsAg seroconversion in a subgroup of patients with chronic hepatitis B
Adding pegylated interferon to a current nucleos(t)ide therapy leads to HBsAg seroconversion in a subgroup of patients with chronic hepatitis B
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DOI：
10.1016/j.jcv.2012.01.024
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发表时间：
2012-05-01
影响因子：
8.8
通讯作者：
Schuchmann, Marcus
中科院分区：
文献类型：
--
作者：
Kittner, Jens M.;Sprinzl, Martin F.;Schuchmann, Marcus
背景资料：Nucleos（t）ides有效地阻止了B型肝炎的疾病进展，但需要长期药物治疗。Objectives：To determine whether add-on of peg-IFN to a ongoing nucleos（t）ide therapy accelerates decline of HBsAg and induces seroconversion.Study design：We observed HBsAg kinetics in 12 patients on a stable oral therapy with undetectable HBV-DNA who additionally received peg-IFN-alfa 2a as a individualized therapy. HBeAg阳性3例。平均基线HBsAg为4695（范围16- 15，120）IU/ml。结果：2例患者中观察到HBsAg持续下降。斜率分别在第8周或第16周变得可检测。HBsAg在第48周下降了2.90 log（10）或4.25 log（10）倍，抗-HBs在第40或32周出现。患者A -HBe阳性，基因型A，F3纤维化-接受恩替卡韦加替诺福韦治疗10个月，HBV-DNA阴性。以前用聚乙二醇干扰素治疗不成功，但现在患者在第24周发生HBeAg血清转换。患者B - HBeAg阴性，基因型D，肝硬化-具有16 U/l的低初始HBsAg水平。接受恩替卡韦治疗后，他的HBV-DNA在27个月内无法检测到。在其余10例患者中，HBsAg在8-24周（平均16.4周）后平均仅下降0.09 log（10）（范围0.01-0.25 log（10）），因此停用聚乙二醇干扰素。没有预料不到的副作用observed.Discussion：我们观察到，添加聚乙二醇干扰素诱导HBsAg血清转换中的2个12例。缓解率可能随着治疗时间的延长而升高。该附加概念值得在临床试验中进行评估。(C)2012年爱思唯尔B。版权所有© 2016
Background: Nucleos(t)ides effectively halt disease progression in hepatitis B but require long-term medication.Objectives: To determine whether add-on of peg-IFN to an ongoing nucleos(t)ide therapy accelerates decline of HBsAg and induces seroconversion.Study design: We observed HBsAg kinetics in 12 patients on a stable oral therapy with undetectable HBV-DNA who additionally received peg-IFN-alfa 2a as an individualized therapy. 3 patients were HBeAg positive. Mean baseline HBsAg was 4695 (range 16-15,120) IU/ml.Results: A continuous decline of HBsAg was observed in 2 patients. The slope, respectively, became detectable at week 8 or 16. HBsAg had dropped by 2.90 log(10) or 4.25 log(10) fold at week 48, and anti-HBs appeared at week 40 or 32. Patient A - HBe-positive, genotype A, F3 fibrosis - had been HBV-DNA negative for 10 months receiving entecavir plus tenofovir. Previous therapy with peg-IFN had been unsuccessful, but now the patient experienced HBeAg seroconversion at week 24. Patient B - HBeAg negative, genotype D, cirrhosis - had a low initial HBsAg level of 16 U/l. Receiving entecavir, his HBV-DNA had previously been non-detectable for 27 months. In the remaining 10 patients HBsAg declined only by a mean of 0.09 log(10) (range 0.01-0.25 log(10)) after 8-24 (mean 16.4) weeks, and therefore, peg-IFN was stopped. No unexpected side effects were observed.Discussion: We observed that the add-on of peg-IFN induced HBsAg seroconversion in 2 out of 12 patients. Response rates may have been higher with prolongation of therapy. The add-on concept merits to be evaluated in a clinical trial. (C) 2012 Elsevier B. V. All rights reserved.