标题: AASLD 2011:Peginterferon is superior to prolonged entecavir therapy for serologi [打印本页] 作者: StephenW 时间: 2011-10-25 19:16 标题: AASLD 2011:Peginterferon is superior to prolonged entecavir therapy for serologi
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Peginterferon is superior to prolonged entecavir therapy for serological response in HBeAg-positive chronic hepatitis B
R. Zoutendijk1; M. J. Sonneveld1; B. E. Hansen1; H. L. Janssen1
1. Gastroenterology and Hepatology, Erasmus MC, Rotterdam, Netherlands.
Background
Hepatitis B e Antigen (HBeAg) seroconversion and Hepatitis B surface Antigen (HBsAg) seroclearance confer an improved prognosis. These endpoints are more often achieved with one year peginterferon (PEG-IFN) compared to one year of nucleosi(t)ide analogues (NA), but prolonged NA therapy may result in serological response rates similar to those achieved with PEG-IFN.
Methods
A total of 266 HBeAg-positive CHB patients were treated with PEG-IFN±lamivudine for one year and 91 NA-naïve patients were treated with prolonged ETV. Follow-up was terminated in patients retreated with NA after PEG-IFN.
Results
Median follow-up was 92 weeks (IQR 78–198) for PEG-IFN patients, and 92 (IQR 50-132) for ETV patients. Groups were balanced for HBV genotype, age, sex and previous IFN. Baseline HBV DNA and ALT were higher in PEG-IFN patients (9.1 vs. 8.0 log copies/mL (p<0.001) and 4.3 vs. 3.1xULN (p=0.004)). One-hundred-fourteen (32%) patients achieved HBeAg seroconversion after 78 weeks (IQR 52–120). The cumulative probability of HBeAg seroconversion was higher in PEG-IFN treated patients (p=0.007). PEG-IFN was an independent determinant of HBeAg seroconversion in a Cox model; hazard rate (HR) for PEG-IFN versus ETV was 3.16 (p<0.001), adjusted for genotype, age, ALT and HBV DNA (Figure). Thirty (8%) patients cleared HBsAg in 92 (78–170) weeks. The cumulative probability of HBsAg loss was higher in patients receiving PEG-IFN (p=0.032). PEG-IFN therapy was independently associated with HBsAg clearance, with a HR of 5.66 (p=0.027) adjusted for genotype, age and previous IFN.
Conclusion
PEG-IFN results in higher rates of HBeAg seroconversion and HBsAg clearance than prolonged ETV therapy, also after adjustment for baseline factors. This shows that PEG-IFN remains an important treatment option in HBeAg-positive CHB patients to achieve serological response.