聚乙二醇干扰素序贯疗法治疗HBeAg反应性小儿慢性乙型肝炎 -

StephenW

Indian J Gastroenterol. 2018 Aug 31. doi: 10.1007/s12664-018-0878-1. [Epub ahead of print]
Pegylated interferon-based sequential therapy for treatment of HBeAg reactive pediatric chronic hepatitis B-First study in children.
Lal BB1, Sood V1, Khanna R1, Rawat D1, Verma S1, Alam S2.
Author information

1
    Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110 070, India.
2
    Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110 070, India. [email protected].

Abstract
BACKGROUND:

Our aim was to evaluate the efficacy and safety of sequential therapy using pegylated interferon (Peg-IFN) and nucleos(t)ide analogue (NA) for treatment of children in immunoactive (IA) and immunotolerant (IT) phases of chronic hepatitis B.
METHODS:

It was a prospective observational study where those willing for sequential therapy were allocated to group 1 (sequential therapy) and others to group 2 (standard therapy). Sequential therapy included 8 weeks of NA followed by 44 weeks of combination of NA and Peg-IFN. In group 2, IA children received NA monotherapy, and IT children received no therapy. HBe seroconversion, HBs seroconversion, and loss of HBV DNA were the major outcome measures.
RESULTS:

A total of 61 children (36 IA and 25 IT) were included in the analysis. Among the IA children, 17 received sequential therapy and 19 received standard therapy; whereas, among the IT children, 12 received sequential therapy and 13 did not receive any therapy. In IA phase, sequential therapy led to higher HBe seroconversion (64.7% vs. 21.05%, p = 0.017) and higher virological clearance (94.12% vs. 52.63%, p = 0.008). In IT children, there was no benefit of treatment with sequential therapy over observation alone. Baseline ALT > 100 IU/L predicted response to therapy with 100% sensitivity, 89.5% specificity, and LR+ of 9.52.
CONCLUSION:

Sequential therapy leads to higher HBe seroconversion and virological response in children in IA phase. Children with baseline ALT > 100 IU/mL are more likely to respond to sequential therapy. There appears to be no role of sequential therapy in children in IT phase.
KEYWORDS:

Immunoactive; Immunotolerant; Pediatric hepatitis B; Pegylated interferon

PMID:
    30168073
DOI:
    10.1007/s12664-018-0878-1

StephenW

印度J Gastroenterol。 2018年8月31日doi：10.1007 / s12664-018-0878-1。 [提前打印]
聚乙二醇干扰素序贯疗法治疗HBeAg反应性小儿慢性乙型肝炎 - 儿童第一次研究。
Lal BB1，Sood V1，Khanna R1，Rawat D1，Verma S1，Alam S2。
作者信息

1
    肝脏和胆道科学研究所儿科肝病学系，D-1，Acharya Shree Tulsi Marg，Vasant Kunj，新德里，110 070，印度。
2
    肝脏和胆道科学研究所儿科肝病学系，D-1，Acharya Shree Tulsi Marg，Vasant Kunj，新德里，110 070，印度。 [email protected]。

抽象
背景：

我们的目的是评估使用聚乙二醇化干扰素（Peg-IFN）和核苷（酸）类似物（NA）的序贯疗法治疗慢性乙型肝炎免疫活性（IA）和免疫耐受（IT）阶段儿童的疗效和安全性。
方法：

这是一项前瞻性观察性研究，其中那些愿意接受序贯治疗的患者被分配到第1组（序贯治疗），其他人则分配到第2组（标准治疗）。顺序治疗包括8周的NA，然后是44周的NA和Peg-IFN的组合。在第2组中，IA儿童接受NA单药治疗，IT儿童未接受任何治疗。 HBe血清学转换，HBs血清学转换和HBV DNA缺失是主要的结局指标。
结果：

共有61名儿童（36名IA和25名IT）被纳入分析。在IA儿童中，17名接受序贯治疗，19名接受标准治疗;而在IT儿童中，12名接受序贯治疗，13名未接受任何治疗。在IA期，序贯治疗导致HBe血清学转换率更高（64.7％vs。21.05％，p = 0.017）和更高的病毒学清除率（94.12％vs。52.63％，p = 0.008）。在IT儿童中，单独观察顺序疗法治疗没有益处。基线ALT> 100 IU / L预测对治疗的反应，灵敏度为100％，特异性为89.5％，LR +为9.52。
结论：

序贯疗法导致IA期儿童的HBe血清转换和病毒学应答更高。基线ALT> 100 IU / mL的儿童更有可能对顺序疗法做出反应。在IT阶段，儿童似乎没有顺序疗法的作用。
关键词：

免疫活性;免疫耐受;小儿乙型肝炎;聚乙二醇干扰素

结论：
    30168073
DOI：
    10.1007 / s12664-018-0878-1