Real-world study on HBsAg loss of combination therapy in HBeAg-negative chronic hepatitis B patients
Jun-Hao Chu 1 , Yan Huang 2 , Dong-Ying Xie 1 3 4 , Hong Deng 1 3 4 , Jia Wei 5 , Yu-Juan Guan 6 , Guo-Jun Li 7 , Yi-Lan Zeng 8 , Jia-Hong Yang 9 , Xin-Yue Chen 10 , Jia Shang 11 , Jia-Bin Li 12 , Na Gao 1 , Zhi-Liang Gao 1 3 4
Affiliations
Affiliations
1
Department of Infectious Diseases, the Third Affiliated Hospital, Sun Yat-Sen University, Guandong 510630, Guangzhou, China.
2
Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
3
Guandong Key Laboratory of Liver Disease Reaserch , the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guandong 510630, China.
4
Key Laboratory of Tropical Disease Control (Sun Yat-Sen University) , Minsitry of Education, Guangzhou , Guandong 510080, China.
5
Department of Gastroenterology, the Second People's Hospital Yunnan Province, Kunming, Yunnan 650021, China.
6
Department of Hepatology, Guangzhou Eighth People's Hospital, Guangzhou, Guandong 510440, China.
7
Department of Hepatology , Shenzhen Third People's Hospital, Shenzhen, Guandong 518112, China.
8
Department of Hepatology, Chengdu Public Health Clinical Medical Center, Chendu, Sichuan 610066, China.
9
Department of Infectious Diseases, Deyang people's Hospital, Deyang, Sichuan 618099, China.
10
Department of Hepatology , Beijing You'an Hospital, Capital Medical University, Beijing 100069, China.
11
Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, China.
12
Department of Infectious Diseases, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China.
PMID: 35718996 DOI: 10.1111/jvh.13722
Abstract
Combination therapy with pegylated interferon (PEG-IFN) and nucleos(t)ide analogs (NAs) can enhance hepatitis B surface antigen (HBsAg) clearance. However, the specific treatment strategy and the patients who would benefit the most are unclear. Therefore, we assessed the HBsAg loss rate of add-on PEG-IFN and explored the factors associated with HBsAg loss in chronic hepatitis B (CHB) patients. This was a real-world cohort study of adults with CHB. Hepatitis B e antigen (HBeAg)-negative NAs-treated patients with baseline HBsAg ≤ 1,500 IU/mL and HBV DNA < the lower limit of detection, or 100 IU/mL, received 48 weeks of add-on PEG-IFN. The primary outcome of the study was the rate of HBsAg loss at 48 weeks of combination treatment. Using multivariable logistic regression analysis, we determined factors associated with HBsAg loss. HBsAg loss in 2,579 patients (mean age: 41.2 years; 80.9% male) was 36.7% (947 patients) at 48 weeks. HBsAg loss was highest in patients from south-central and southwestern China (40.0%). Factors independently associated with HBsAg loss included: increasing age (odds ratio = 0.961); being male (0.543); baseline HBsAg level (0.216); HBsAg decrease at 12 weeks (between 0.5 and 1.0 log10 IU/mL [2.405] and > 1.0 log10 IU/mL [7.370]); alanine aminotransferase (ALT) increase at 12 weeks (1.365); hemoglobin (HGB) decrease at 12 weeks (1.558). There was no difference in the primary outcomes associated with the combination regimen. In conclusion, HBsAg loss by combination therapy was higher in patients from southern China than those from the north. An increased chance of HBsAg loss was associated with baseline characteristics and dynamic changes in clinical indicators.