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P0669
CONSOLIDATION THERAPY WITH ENTECAVIR CAN PREVENT
POST-TREATMENT HBsAg REBOUND IN HBeAg-POSITIVE
CHRONIC HEPATITIS B PATIENTS TREATED WITH
PEGINTERFERON ALPHA
W.P. Brouwer1, M.J. Sonneveld1, Q. Xie2, N. Zhang3, S. Zeuzem4,
F. Tabak5, Q. Zhang6, K. Simon7, U.S. Akarca8, A. Streinu-Cercel9,
B. Hansen1, H.L. Janssen10. 1Gastroenterology & Hepatology,
Erasmus MC Rotterdam, Rotterdam, Netherlands; 2Gastroenterology &
Hepatology, Infectious Diseases, Ruijin Hospital, Jiaotong University,
3Gastroenterology & Hepatology, Zhong Shan Hospital, Fu Dan
University, Shanghai, China; 4Gastroenterology & Hepatology,
Medizinische Klinik 1, Klinikum der Johann Wolfgang Goethe-
Universit¨at, Frankfurt am Main, Germany; 5Gastroenterology &
Hepatology, Cerrahpasa Medical Faculty, Istanbul, Turkey;
6Gastroenterology & Hepatology, Shanghai Public Health Center, Fu
Dan University, Shanghai, China; 7Gastroenterology & Hepatology,
Wroclaw Medical University, Wroclaw, Poland; 8Gastroenterology &
Hepatology, Ege ¨ Universitesi Tip Fakultesi, Bornova, Turkey;
9Gastroenterology & Hepatology, National Institute of Infectious
Disease, Bucharest, Romania; 10Gastroenterology & Hepatology, Center
for Liver Disease, Toronto Western and General Hospital, University
Health Network, Toronto, Canada
E-mail: [email protected]
Background and Aims: It is unknown whether adding-on
peginterferon (PEG-IFN) to entecavir (ETV) leads to more HBsAg
decline compared to PEG-IFN monotherapy or de novo combination
therapy, and whether consolidation therapy prevents HBsAg relapse
after PEG-IFN cessation.
Methods: We performed a post-hoc comparison of 396 HBeAgpositive
patients treated for 72 weeks with ETV + 24 weeks PEGIFN
add-on from week 24–48 (add-on, n = 85), 72 weeks with
ETV monotherapy (n = 90), 52 weeks with PEG-IFN monotherapy
(n = 111) and 52 weeks PEG-IFN + LAM (combination, n = 110) within
2 international randomized trials (ARES and HBV 9901 respectively).
The extent of HBsAg decline was assessed on-treatment, at end-of
PEG-IFN (EOT) and 6 months after PEG-IFN (EOF). Differences in
baseline characteristics were accounted for using propensity scores
as inversed weighting in regression analysis.
Results: Of 396 patients, 75% was male, mean age was 33
years and HBV genotype A/B/C/D was present in 22%/13%/27%/36%
respectively. For add-on, combination, PEG-IFN mono and ETV
the mean estimated HBsAg level decline achieved at EOT was
−0.80, −1.27, −0.77 and −0.32 log IU/mL (combination vs add-on
p = 0.045) and −0.84, −0.81, −0.68, and −0.33 log IU/mL, at EOF
respectively (p > 0.05 for PEG-IFN arms). The estimated proportion
of patients with ≥1 log10 HBsAg reduction from baseline at EOT and
EOF was 36% and 40% for add-on, 36% and 22% for combination,
20% and 18% for PEG-IFN mono and 8% and 15% for ETV, respectively
(p = 0.984 and p = 0.029 for add-on vs combination at EOT and
EOF, figure). Patients treated with PEG-IFN + NUC more frequently
achieved a HBsAg decline ≥1 log10 at one year (36% vs 20%), but
this advantage was only sustained in patients who continued ETV
therapy until 6 months post PEG-IFN discontinuation: the estimated
proportion of patients who relapsed from >1 at EOT to <1 log10
HBsAg reduction at EOF was 5%, 46%, 38% and 0%, respectively.
Estimated HBeAg loss rates at EOT were 22%, 40%, 27% and 11%
(p = 0.039 for add-on vs combination) and 35%, 31%, 33% and 23%
at EOF (p > 0.05 for PEG-IFN arms).
Conclusions: The combination of PEG-IFN with a NUC either as
de novo for 52 weeks or as add-on for 24 weeks results in more
on-treatment HBsAg decline than does 52 weeks of PEG-IFN alone.
Continuation of ETV after PEG-IFN discontinuation may prevent
HBsAg rebound. Future randomized trials should evaluate the role
of consolidation therapy.
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发表于 2015-5-24 18:03
