Adding Pegylated Interferon to Antivirals for Hepatitis B May Lead to HBsAg Loss
Written by Liz Highleyman
Addition of pegylated interferon to nucleoside/nucleotide antivirals increases the likelihood of hepatitis B surface antigen (HBsAg) loss -- considered a cure -- in people with hepatitis B "e" antigen (HBeAg) negative chronic hepatitis B, according to a report in December 2013 edition of Journal of Clinical Virology.
Nucleoside/nucleotide analogs such as tenofovir (Viread) or entecavir (Baraclude) effectively suppress hepatitis B virus (HBV) replication, but they usually do not eradicate the virus and may need to be taken long term. Serological response, or changes in hepatitis B antigen and antibody status, is more difficult to achieve than virological response, or undetectable viral load.
Denis Ouzan of Institut Arnault Tzanck in France and colleagues conducted a study to evaluate whether adding pegylated interferon alfa-2a (Pegasys) leads to HBsAg loss in HBeAg negative patients with chronic hepatitis who have fully suppressed HBV DNA on stable long-term nucleoside/nucleotide analog treatment.
This prospective analysis included 10 HBeAg negative but HBsAg positive patients. Before starting pegylated interferon, their HBV viral load had been below the limit of detection for at least 3 years. Treatment with add-on pegylated interferon lasted a maximum of 96 weeks, depending on changes in HBsAg levels.
Results
HBsAg levels declined in 9 out of 10 patients.
Among these 9, 4 became HBsAg negative after 48 weeks on pegylated interferon, and they stopped interferon at that point.
These 4 patients also stopped nucleoside/nucleotide analogs, and HBsAg remained negative and HBV DNA remained undetectable for at least 18 months.
2 patients experienced HBs seroconversion.
The 5 patients without early HBsAg decline received pegylated interferon for 96 weeks.
1 patient became HBsAg negative at the end of interferon therapy, while another became HBsAg negative 6 months later.
Both stopped nucleoside/nucleotide analogs and did not relapse during 12 months of follow up.
The remaining 3 patients never became HBsAg negative.
Based on these findings, the study authors concluded, "In HBsAg positive, HBeAg negative patients with HBV DNA fully suppressed by long-term NA treatment, the addition of pegylated interferon for a maximum of 96 weeks based on HBsAg titer monitoring led to a loss of HBsAg and cessation of NA therapy in 6 out of 10 patients, with no relapse for 12-18 months of follow up."
12/23/13
Reference
D Ouzan, G Pénaranda, H Joly, et al. Add-on peg-interferon leads to loss of HBsAg in patients with HBeAg-negative chronic hepatitis and HBV DNA fully suppressed by long-term nucleotide analogs. Journal of Clinical Virology 58(4):713-717. December 2013.