AASLD 2011:Add -on of peg interferon to a stable nucleoside regimen led to loss

StephenW

Add -on of peg interferon to a stable nucleoside regimen led to loss of HBs Ag in chronic hepatitis HBe Ag negative patients
D. Ouzan1; G. Penaranda2; H. Joly1; H. Khiri2; P. Halfon2
1. Institut Arnault Tzanck, Saint-Laurent du Var, France.
2. Laboratoire ALPHABIO, Marseille, France.


Objectives: Suppression of HBV viral load by nucleoside treatment reduces disease progression but requires indefinite treatment. Hbs Ag loss is a rare event after long term treatment with analogues therapy. In HBe Ag negative patients peg interferon alpha 2a for 96 weeks improved the sustained responses rate versus 48 weeks. It is of interest to know whether the addition of peg interferon for 96 weeks to a stable nucleoside therapy will reduce quantitative HBs-Ag which may follow by HBs Ag loss.
Methods: We analyzed HBs Ag levels of 10 patients who received additional peg –interferon alpha2a as an individualized therapy during 96 weeks according to the evolution of HBsAg titer. All patients were male; HBe Ag negative; median age was 58 (range 41-76) years. Current treatments were lamivudine (one patient) adefovir (three patients), entecavir (two patients), lamivudine + adefovir (two patients), adefovir+entecavir (two patients). Median baseline HBsAg was 660 IU/ml range (50-1754). HBV DNA was below the limit of detection <20UI/ml in all patients for more than 3 years.
Results: During add-on therapy, in four patients, a continuous decline of quantitative HBs Ag lead to negative values <10 UI/ml between 24 and 48 weeks. All antiviral (peg interferon and nucleoside analogue) therapy was stopped at week 48 in these 4 patients and results remain the same 24 week after cessation of all therapy (AgHBs loss and HBV DNA negative). HBs serocoversion was observed in one out of these four patients. Quantitative HBsAg highly decreased in five of the remaining six patients. For one patient, HBsAg remained high; treatment was stopped in this patient at week 24. The remaining five patients received peg interferon for 72 week at the time of this analysis. Median decrease of quantitative HBs Ag was 834 IU/ml in these five patients (compared with a decrease of 34 IU/ml in the patient with low decrease).
Conclusions: In patients with sustained virological remission under long term nucleoside analogue therapy, add-on of peg interferon allows HBsAg loss in 40% of our patients. HBsAg titer decline constitutes a useful tool which predicts the loss of HBsAg and may lead to the optimal duration of IFN therapy.

StephenW

加入到一个稳定的核苷方案PEG干扰素在慢性肝炎HBE AG阴性的患者导致的损失HBS银
D. Ouzan 1; G.佩尼亚兰达2; H.乔利1; H. Khiri 2 P. Halfon 2
1。圣洛朗杜VAR，法国阿尔诺Tzanck，研究所。
2。 Laboratoire ALPHABIO，法国马赛​​。


目标：制止核苷治疗乙肝病毒载量减少了疾病的进展，但需要无限期治疗。哈佛商学院的银损失是一个罕见的事件经过长期类似物治疗的长期治疗。 HBE银PEG干扰素α2A阴性的患者为96周改善与48周的持续反应率。它是知道PEG干扰素96周除了一个稳定的核苷治疗是否会降低乙型肝炎表面抗原定量可能遵循由哈佛商学院银损失的利益。
方法：我们分析了10例期间收到的96周的聚乙二醇干扰素alpha2a作为个体化治疗乙肝表面抗原滴度的演变HBs的银水平。所有患者均为男性; HBE抗原阴性;年龄中位数为58（范围41-76）岁。目前的治疗拉米夫定（3例）（1例）阿德福韦，恩替卡韦（2例），拉米夫定+阿德福韦（2例），阿德福韦+恩替卡韦（2例）。基线HBsAg的中位数是660 IU / ml范围内（50-1754）。所有患者HBV - DNA低于检测限<20UI/ml 3年以上。
结果：在附加的治疗，4例患者，定量HBS公司的持续下降导致负值<10 24和48周之间的UI /毫升。停止所有抗病毒药物（PEG干扰素和核苷类似物）治疗48周时在这4例，结果仍然相同停止一切治疗后24周（AgHBs损失和HBV DNA负）。这四个病人在一个哈佛商学院serocoversion观察。定量HBsAg的高度下降，其余6例患者5。对于一个病人，乙肝表面抗原仍然很高，在这名病人治疗24周时停止。其余5例患者接受72周PEG干扰素在这一分析的时间。定量HBS AG的中位数下降为834国际单位/毫升在这5例（去年同期减少34 IU / ml的患者低减少）。
结论：根据长期的核苷类似物治疗的持续病毒学缓解患者，PEG干扰素允许在40％的患者乙肝表面抗原的损失。乙肝表面抗原滴度下降构成一个有用的工具，它预测HBsAg的损失，并可能导致干扰素治疗的最佳时间。