系统回顾荟萃分析：联合治疗基于聚乙二醇干扰素治疗慢性

StephenW

Aliment Pharmacol Ther. 2018 Mar 26. doi: 10.1111/apt.14629. [Epub ahead of print]
Systematic review with meta-analysis: combination treatment of regimens based on pegylated interferon for chronic hepatitis B focusing on hepatitis B surface antigen clearance.Qiu K1, Liu B1, Li SY1, Li H1, Chen ZW1, Luo AR1, Peng ML1, Ren H1, Hu P1.
Author information
1The Key Laboratory of Molcular Biology for Infectious Diseases, Department of Infectious Diseases, Institute for Viral Hepatitis, Chinese Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

AbstractBACKGROUND: The seroclearance of hepatitis B surface antigen (HBsAg) in patients with chronic hepatitis B (CHB) is considered to be associated with favourable clinical outcomes.
AIMS: This meta-analysis was performed to establish the proportion of HBsAg loss rates among CHB patients who received combination treatment based on pegylated interferon (PegIFN). Four combination strategies have been studied with the aim of improving HBsAg loss: "de novo," "NA-experienced," "switch-to" and "add-on." This meta-analysis was performed to determine which, if any, of these combination strategies was more effective.
METHODS: Medline, Web of Science and Embase databases were searched from inception to December 2017. The proportion of patients who achieved HBsAg loss after combination therapy was pooled using a random-effects model.
RESULTS: Twenty-four studies fulfilled the meta-analysis criteria. The overall pooled proportion suggested that the rate of HBsAg loss could be increased to 9% (95% CI: 7%-12%) based on the combination treatment in CHB patients. Compared with "de novo" strategy (8%, 95% CI: 6%-10%), the "nucleos(t)ide analogues-experienced" (11%, 95% CI: 8%-15%) was found to be more likely (P = 0.036) to achieve a response. Compared with the "add-on" strategy (8%, 95% CI: 5%-13%), the "switch-to" (14%, 95% CI: 9%-20%) was found to be more likely (P = 0.012) to achieve HBsAg loss.
CONCLUSION: The "nucleos(t)ide analogues-experienced" strategy was more effective than the "De novo" strategy in achieving HBsAg loss for CHB patients. Combination treatment using regimens based on Peg-IFN may be useful to help nucleos(t)ide analogues-treated patients, who have experienced at least 48 weeks of nucleot(s)ide analogue, achieve HBsAg seroclearance.

© 2018 John Wiley & Sons Ltd.

PMID:29577360DOI:10.1111/apt.14629

StephenW

Aliment Pharmacol Ther。 2018年3月26日doi：10.1111 / apt.14629。 [电子版提前打印]
系统回顾荟萃分析：联合治疗基于聚乙二醇干扰素治疗慢性乙型肝炎的重点是乙型肝炎表面抗原清除。
邱1 1，刘蓓1，李茜1，李曦1，陈中伟1，罗镭1，彭ML​​1，任海1，胡鹏1。
作者信息

1
    重庆医科大学附属第二医院教育部病毒性肝炎研究所传染病科传染病研究所重点实验室

抽象
背景：

慢性乙型肝炎（CHB）患者中乙型肝炎表面抗原（HBsAg）的清除被认为与有利的临床结果有关。
目的：

这项荟萃分析是为了确定基于聚乙二醇干扰素（PegIFN）联合治疗的慢性乙型肝炎患者中HBsAg消失率的比例。已经研究了四种组合策略，目的是改善HBsAg消失：“从头”，“无NA”，“切换”和“附加”。这个荟萃分析是为了确定哪些（如果有的话）这些组合策略更有效。
方法：

Medline，Web of Science和Embase数据库从开始到2017年12月进行检索。联合治疗后达到HBsAg消失的患者比例采用随机效应模型进行汇总。
结果：

二十四项研究符合荟萃分析标准。总体汇总比例表明，基于CHB患者的联合治疗，HBsAg消失率可增加至9％（95％CI：7％-12％）。与“从头”策略（8％，95％CI：6％-10％）相比，发现“核苷（酸）类似物经历”（11％，95％CI：8％-15％）更有可能（P = 0.036）来实现响应。与“附加”策略（8％，95％CI：5％-13％）相比，“转向”（14％，95％CI：9％-20％）被认为更可能（P = 0.012）以实现HBsAg消失。
结论：

经验丰富的“核苷（酸）类似物”策略比CHB患者实现HBsAg消失时的“从头”策略更有效。使用基于Peg-IFN的方案进行联合治疗可能有助于帮助核苷（酸）类似物治疗的患者经历至少48周的核苷酸类似物，实现HBsAg血清学清除。

©2018 John Wiley＆Sons Ltd.

结论：
    29577360
DOI：
    10.1111 / apt.14629