AASLD 2011:Peginterferon is superior to prolonged entecavir therapy for serologi

StephenW

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.





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StephenW

聚乙二醇是卓越的长期恩替卡韦治疗HBeAg阳性慢性乙型肝炎血清学反应
R. Zoutendijk 1兆焦耳Sonneveld1; Hansen1; HL Janssen1
1。胃肠病学和肝病学杂志，鹿特丹，荷兰，伊拉斯谟MC。


背景
B型肝炎e抗原（HBeAg）血清转换和乙肝表面抗原（HBsAg）seroclearance赋予改善预后。更多的时候，这些端点实现一年聚乙二醇（PEG - IFN）nucleosi（T）IDE类似物（NA）的相比，但长期无治疗可能会导致类似PEG -干扰素取得的血清学反应率。
方法
PEG -干扰素±拉米夫定为一年，共有266 HBeAg阳性慢性乙型肝炎患者治疗91 NA初治患者与长期教育电视处理。与Na撤退后，PEG -干扰素的患者在随访终止。
结果
中位随访92周（IQR 78-198）PEG -干扰素的患者，92（IQR 50-132）教育电视患者。组是平衡的基因型，年龄，性别和以前的干扰素。基线HBV DNA和ALT均高于PEG -干扰素的患者（9.1 - 8.0日志拷贝/ ml（P <0.001）和4.3与3.1xULN（P = 0.004））。有一百十四（32％）患者达到HBeAg血清转换后，78周（​​IQR 52-120）。 PEG -干扰素治​​疗的患者（P = 0.007），HBeAg血清转换的累积概率较高。 PEG -干扰素在Cox模型对HBeAg血清转换的独立因素; PEG -干扰素与教育电视的风险率（HR）为3.16（P <0.001），基因型，年龄，ALT和HBV DNA（图）调整。第三（8％）患者清除乙肝表面抗原92（78-170）周。患者接受聚乙二醇化干扰素（P = 0.032），HBsAg消失的累积概率较高。 PEG -干扰素治​​疗的独立与HBsAg清除，与人力资源的基因型，年龄和以前的干扰素调整了5.66（P = 0.027）。
结论
PEG -干扰素在HBeAg血清转换和HBsAg的基线因素调整后较长期ETV治疗的间隙，还率较高的结果。这表明，PEG -干扰素仍然在HBeAg阳性慢性乙型肝炎患者的重要治疗方案，以实现血清学反应。