J Viral Hepat. 2017 Jun 20. doi: 10.1111/jvh.12738. [Epub ahead of print]
HBsAg loss after peginterferon and nucleotide combination treatment in chronic hepatitis B patients: 5 years of follow-up.Stelma F1, van der Ree MH1, Jansen L1, Peters MW1, Janssen HLA2,3, Zaaijer HL4, Takkenberg RB1, Reesink HW1. Author information 1Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.2Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.3Toronto Centre for Liver Disease, Toronto Western & General Hospital, University Health Network, Toronto, Canada.4Department of Clinical Virology, Academic Medical Center, Amsterdam, The Netherlands.
AbstractBACKGROUND AND AIMS: Combining peginterferon alfa-2a (pegIFN) with a nucleotide analogue can result in higher rates of HBsAg loss than either therapy given alone. Here we investigated the durability of the response to combination therapy in chronic hepatitis B (CHB) patients after 5 years of follow-up.
METHODS: In the initial study, 92 CHB patients (44 HBeAg positive, 48 HBeAg negative) with HBV DNA > 100,000 c/mL (~20,000 IU/mL) and active hepatitis were treated for 48 weeks with pegIFN 180 μg/week and 10 mg adefovir dipivoxil daily. For the long term follow-up study, patients were followed-up for 5 years after the end of treatment. At year 5, 70 (32 HBeAg positive, 38 HBeAg negative) patients remained in the study.
RESULTS: At year 5, 19% (6/32) of HBeAg positive patients and 16% (6/38) of HBeAg negative patients lost HBsAg, and no HBsAg sero-reversion was observed. The 5-year cumulative Kaplan-Meier estimate for HBsAg loss was 17.2% for HBeAg positive patients and 19.3% for HBeAg negative patients. 14/16 patients who lost HBsAg at any time point during follow-up developed anti-HBs antibodies (>10 IU/L). At year 5, in total 63% (20/32) of HBeAg positive and 71% (27/38) of HBeAg negative patients were retreated with nucleos(t)ide analogues during follow-up. The cumulative Kaplan-Meier estimate for retreatment was 60% of patients at year 5.
CONCLUSION: At year 5 of follow-up, 18% of CHB patients treated with pegIFN/ nucleotide analogue combination therapy had durable HBsAg loss and 88% of these had developed anti-HBs antibodies. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS: Hepatitis B virus; combination treatment; functional cure; long term follow-up; nucleotide analogue; peginterferon; quantitative HBsAg