基于聚乙二醇化干扰素α的联合治疗改善了24周时表现出高水

StephenW

Medicine (Baltimore). 2019 Sep;98(36):e17022. doi: 10.1097/MD.0000000000017022.
Combination therapy based on pegylated interferon alfa improves the therapeutic response of patients with chronic hepatitis B who exhibit high levels of hepatitis B e-antigen at 24 weeks: A retrospective observational study.
Zhang Y1,2, Li W3, Liu Z2, Ye J2, Zou G2, Zhang Z2, Li J1.
Author information

1
    Department of Infectious Diseases, The First Affiliated Hospital, Anhui Medical University.
2
    Department of Infectious Diseases, The Second Affiliated Hospital, Anhui Medical University, Hefei.
3
    Department of Liver Diseases, Fuyang Second People's Hospital, Fuyang, China.

Abstract

Pegylated interferon alpha (PEG-IFN-α) is a first-line treatment for patients with chronic hepatitis B (CHB), but its efficacy varies from individual to individual. Early discrimination between responder and non-responder patients is important for optimal clinical management. In addition, low therapeutic efficacy is still a major issue; thus, treatment timing should be optimized.We reviewed our experience with hepatitis B e-antigen (HBeAg)-positive patients treated with PEG-IFN-α, alone or in combination with nucleoside analogues (NAs), from 2009 through 2014. Collected data included both general characteristics of 113 patients and laboratory data at baseline and at treatment weeks 12, 24, 52, and 76. The endpoint was HBeAg seroconversion at week 76.A total of 113 patients with changed to or start of NAs therapy were included in this study. At the end of treatment, 44 (38.9%) patients exhibited HBeAg seroconversion. Patients with HBeAg seroconversion had lower baseline HBeAg (475.5 vs 751.7; P = .007). The incidence of HBeAg seroconversion was significantly higher among patients with HBeAg ≤ 500 signal-to-cutoff ratio (S/CO) (OR = 2.60, 95% CI: 1.16-5.83, P = .02) at baseline, HBeAg S/CO ≤ 20 (OR = 3.37, 95% CI: 1.47-7.73, P = .003), or a higher than 10-fold HBeAg drop (OR = 3.55, 95% CI: 1.50-8.37, P = .003) at week 12 or HBeAg ≤ 15 S/CO (OR = 10.35, 95% CI: 4.09-26.20, P < .001) at week 24. Subgroup analyses demonstrated that in patients with HBeAg >20 S/CO at 24 weeks, the addition of NAs treatment may increase HBeAg seroconversion (23.3% vs 0%, P = .03).HBeAg levels had an impact on the rate of serological conversion in CHB patients receiving PEG-IFN-based treatment. Combination therapy with NAs should be considered in CHB patients maintaining a high HBeAg level after 24 weeks of PEG-IFN monotherapy.

PMID:
    31490387
DOI:
    10.1097/MD.0000000000017022

StephenW

医学（巴尔的摩）。 2019年9月; 98（36）：e17022。 doi：10.1097 / MD.0000000000017022。
基于聚乙二醇化干扰素α的联合治疗改善了24周时表现出高水平乙型肝炎e抗原的慢性乙型肝炎患者的治疗反应：一项回顾性观察研究。
Zhang Y1,2，Li W3，Liu Z2，Ye J2，Zou G2，Zhang Z2，Li J1。
作者信息

1
    安徽医科大学第一附属医院感染科
2
    安徽医科大学附属第二医院感染科，合肥。
3
    阜阳市第二人民医院肝病科，阜阳

抽象

聚乙二醇化干扰素α（PEG-IFN-α）是慢性乙型肝炎（CHB）患者的一线治疗方法，但其疗效因人而异。响应者和非响应者之间的早期区分对于最佳临床管理是重要的。此外，低疗效仍是一个主要问题;因此，应优化治疗时机。我们回顾了我们从2009年到2014年单独使用PEG-IFN-α或与核苷类似物（NAs）联合治疗的乙型肝炎e抗原（HBeAg）阳性患者的经验。收集的数据包括113名患者的一般特征和基线时和治疗第12周，第24周，第52周和第76周的实验室数据。终点是第76周的HBeAg血清学转换。总共113名改变或开始NAs治疗的患者被纳入这项研究。治疗结束时，44名（38.9％）患者表现出HBeAg血清学转换。 HBeAg血清学转换患者的基线HBeAg较低（475.5 vs 751.7; P = .007）。在基线HBeAg S / COHBeAg≤500信号与截止比（S / CO）（OR = 2.60,95％CI：1.16-5.83，P = .02）的患者中，HBeAg血清学转换的发生率显着升高≤20（OR = 3.37,95％CI：1.47-7.73，P = .003），或高于10倍的HBeAg下降（OR = 3.55,95％CI：1.50-8.37，P = .003）在第24周时12或HBeAg≤15S / CO（OR = 10.35,95％CI：4.09-26.20，P <.001）。亚组分析表明，在24周时HBeAg> 20 S / CO的患者中， NAs治疗可能增加HBeAg血清学转换（23.3％vs 0％，P = .03）.HBeAg水平对接受基于PEG-IFN治疗的CHB患者的血清学转换率有影响。在PEG-IFN单一疗法24周后，在考虑维持高HBeAg水平的CHB患者中应考虑与NA的联合治疗。

结论：
    31490387
DOI：
    10.1097 / MD.0000000000017022