Peginterferon alpha-based therapy for chronic hepatitis B focusing on HBsAg clearance or seroconversion: a meta-analysis of controlled clinical trials

June 14, 2011

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Peginterferon alpha-based therapy for chronic hepatitis B focusing on HBsAg

clearance or seroconversion: a meta-analysis of controlled clinical trials

(FREE Full Text)

BMC Infectious Diseases, 06/14/2011 â€‚Evidence Based Medicine

Li WC et al. - Pegylated interferon alpha (peginterferon alpha, PEG-IFNalpha)

facilitated HBsAg clearance or seroconversion in chronic hepatitis B (CHB)

patients. PEG-IFNalpha-based therapy was more effective than lamivudine (LAM)

monotherapy in achieving HBsAg clearance or seroconversion for both

HBeAg-positive and HBeAg-negative CHB patients. There was no significant

difference in HBsAg clearance or seroconversion between PEG-IFNalpha/LAM

combination therapy and PEG-IFNalpha monotherapy. PEG-IFNalpha was obviously

superior to conventional IFNalpha in HBsAg clearance, but not in HBsAg

seroconversion. Although PEG-IFNalpha produced significantly higher rates of

HBsAg clearance and seroconversion, the absolute change in the proportion of

HBsAg clearance and seroconversion was low (about 3-6%).

Methodsâ€¢ All available controlled clinical trials, published from 2004 to

2010, with the following antiviral therapies for CHB patients: PEG-IFNalpha

combined with lamivudine (LAM), PEG-IFNalpha only, conventional IFNalpha and

LAM, with a course [greater than or equal to]24 weeks, were meta-analysed for

HBsAg clearance and seroconversion.

Results

â€¢ 14 trials (involving a total of 2,682 patients) were identified, including 7

high-quality and seven low-quality studies.

â€¢ The analysis results of the different antiviral therapies on HBsAg clearance

or seroconversion were as follows:

â—¦ No significant difference in HBsAg clearance or seroconversion was observed

between the combination therapy group and PEG-IFNalpha monotherapy group [odds

ratio (OR) = 1.16, 95% confidence intervals (CI) (0.73-1.85), P = 0.54 and OR =

1.07, 95% CI (0.58-1.97), P = 0.82, respectively]

â—¦ HBsAg clearance and seroconversion rates in patients with combination

therapy were markedly higher than in those with LAM monotherapy [OR = 9.41, 95%

CI (1.18-74.94), P = 0.03, and OR = 12.37, 95% CI (1.60-95.44), P = 0.02,

respectively]

â—¦ There was significant difference in HBsAg clearance between the PEG-IFNalpha

group and IFNalpha monotherapy group [OR = 4.95, 95% CI (1.23-20.00), P = 0.02],

but not in seroconversion [OR = 2.44, 95% CI (0.35-17.08), P = 0.37]; 4.

PEG-IFNalpha was superior to LAM in HBsAg seroconversion [OR = 14.59, 95% CI

(1.91-111.49), P = 0.01].

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http://www.biomedcentral.com/1471-2334/11/165

Research article

Peginterferon alpha-based therapy for chronic hepatitis B focusing on HBsAg

clearance or seroconversion: a meta-analysis of controlled clinical trials

Wen-cong Li , Mao-rong Wang , Ling-bo Kong , Wei-guang Ren , Yu-guo Zhang and

Yue-min Nan

BMC Infectious Diseases 2011, 11:165doi:10.1186/1471-2334-11-165

Published:

9 June 2011

Abstract (provisional)

Background

Interferon alpha (IFNalpha) therapy has been widely used in the treatment of

chronic hepatitis B (CHB) for decades. Nucleos(t)ide analogues are also

increasingly used to treat CHB recently. More and more studies are being carried

out concerning the clearance or seroconversion of HBsAg, which is recognized as

an ideal goal of CHB therapy. This study conducted a meta-analysis to estimate

the effect of pegylated interferon alpha (peginterferon alpha,

PEG-IFNalpha)-based therapy on HBsAg clearance or seroconversion in CHB.

Methods

All available controlled clinical trials, published from 2004 to 2010, with the

following antiviral therapies for CHB patients: PEG-IFNalpha combined with

lamivudine (LAM), PEG-IFNalpha only, conventional IFNalpha and LAM, with a

course [greater than or equal to]24 weeks, were meta-analysed for HBsAg

clearance and seroconversion.

Results

Fourteen trials (involving a total of 2,682 patients) were identified, including

seven high-quality and seven low-quality studies. The analysis results of the

different antiviral therapies on HBsAg clearance or seroconversion were as

follows: 1. No significant difference in HBsAg clearance or seroconversion was

observed between the combination therapy group and PEG-IFNalpha monotherapy

group [odds ratio (OR) = 1.16, 95% confidence intervals (CI) (0.73-1.85), P =

0.54 and OR = 1.07, 95% CI (0.58-1.97), P = 0.82, respectively]; 2. HBsAg

clearance and seroconversion rates in patients with combination therapy were

markedly higher than in those with LAM monotherapy [OR = 9.41, 95% CI

(1.18-74.94), P = 0.03, and OR = 12.37, 95% CI (1.60-95.44), P = 0.02,

respectively]; 3. There was significant difference in HBsAg clearance between

the PEG-IFNalpha group and IFNalpha monotherapy group [OR = 4.95, 95% CI

(1.23-20.00), P = 0.02], but not in seroconversion [OR = 2.44, 95% CI

(0.35-17.08), P = 0.37]; 4. PEG-IFNalpha was superior to LAM in HBsAg

seroconversion [OR = 14.59, 95% CI (1.91-111.49), P = 0.01].

Conclusions

PEG-IFNalpha facilitated HBsAg clearance or seroconversion in CHB patients.

PEG-IFNalpha-based therapy was more effective than LAM monotherapy in achieving

HBsAg clearance or seroconversion for both HBeAg-positive and HBeAg-negative CHB

patients. There was no significant difference in HBsAg clearance or

seroconversion between PEG-IFNalpha/LAM combination therapy and PEG-IFNalpha

monotherapy. PEG-IFNalpha was obviously superior to conventional IFNalpha in

HBsAg clearance, but not in HBsAg seroconversion. Although PEG-IFNalpha produced

significantly higher rates of HBsAg clearance and seroconversion, the absolute

change in the proportion of HBsAg clearance and seroconversion was low (about

3-6%). Therefore, additional interventions are needed to improve the rate of

positive outcomes.

The complete article is available as a provisional PDF. The fully formatted PDF

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June 14, 2011