基于聚乙二醇干扰素的长期治疗方案针对以乙型肝炎表面抗

StephenW

Review
Infect Genet Evol

. 2020 Aug 4;104492.
doi: 10.1016/j.meegid.2020.104492. Online ahead of print.
Extended duration therapy regimens based on Pegylated interferon for chronic hepatitis B patients focusing on hepatitis B surface antigen loss: A systematic review and meta-analysis
Yanpin Ma  1 , Jinhuan Wang  1 , Fang Xiong  1 , Jun Lu  2
Affiliations
Affiliations

    1
    International Medical Department, Beijing You-an Hospital, Capital Medical University, Beijing, China.
    2
    International Medical Department, Beijing You-an Hospital, Capital Medical University, Beijing, China. Electronic address: [email protected].

    PMID: 32763441 DOI: 10.1016/j.meegid.2020.104492

Abstract

Aims: Hepatitis B surface antigen (HBsAg) loss is associated with disease control and improvement of prognosis. Therefore, it is regarded as the optimal treatment endpoint for chronic hepatitis B (CHB) patients. Pegylated interferon (PegIFN)-based extended therapy regimens was assessed in several studies. In order to summarize a conclusion on the HBsAg loss rate and safety in this regimen, a systematic review and meta-analysis was performed.

Methods: Studies on Hepatitis B and PegIFN were searched thoroughly in Pubmed, EMBASE, and the Cochrane Library from inception to November 18, 2019. The primary endpoint of this study was the HBsAg loss rate at the end of the extended duration therapy. The secondary endpoint was safety. All analyses were performed by using the R3.6.1 version Software. Quality assessment of RCTs was carried out by using Review manager 5.3.

Results: A total of nine studies, including 545 CHB patients met the inclusion criteria. The pooled HBsAg loss rate after PegIFN-based extended duration therapy was 11% (95% CI: 0.05-0.19), I2 = 82%, P < 0.01(Q test). The extended duration therapy regimen was safe and tolerable. Subgroup analysis showed HBsAg loss rates were 14% (95% CI: 0.04-0.29) and 10% (95% CI: 0.02-0.20) respectively for HBeAg positive and HBeAg negative patients (P = 0.52). HBsAg loss rates were 11%(95%CI:0.03-0.22)and 12%(95%CI:0.04-0.24)respectively for PegIFN monotherapy and PegIFN with Nucleos(t)ide analogs (NAs) therapy (P = 0.84). HBsAg loss rates were 25% (95% CI: 0.19-0.31) and 8% (95% CI: 0.03-0.15) respectively for the advantageous group and non-advantageous group (P = 0.001).

Conclusions: For CHB patients, extended duration of PegIFNα-based treatment for more than 48 weeks is likely to improve HBsAg clearance rate. Specially, the advantageous group will benefit a lot. In addition, the extended duration therapy regimen is safe and tolerable.

Keywords: Chronic hepatitis B; Hepatitis B surface antigen loss; Meta-analysis; Pegylated interferon; Systematic review.

Copyright © 2020. Published by Elsevier B.V.

StephenW

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感染基因进化

。 2020年8月4日； 104492。
doi：10.1016 / j.meegid.2020.104492。在线印刷。
基于聚乙二醇干扰素的长期治疗方案针对以乙型肝炎表面抗原丢失为重点的慢性乙型肝炎患者：系统评价和荟萃分析
马艳萍1，王金焕1，方雄1，君路2
隶属关系
隶属关系

    1个
    首都医科大学附属北京佑安医院国际医学​​系，北京
    2
    首都医科大学附属北京佑安医院国际医学​​系，北京电子地址：[email protected]。

    PMID：32763441 DOI：10.1016 / j.meegid.2020.104492

抽象

目的：乙型肝炎表面抗原（HBsAg）的丢失与疾病控制和改善预后有关。因此，它被视为慢性乙型肝炎（CHB）患者的最佳治疗终点。在几项研究中评估了基于聚乙二醇干扰素（PegIFN）的扩展治疗方案。为了总结该方案中HBsAg丢失率和安全性的结论，进行了系统的回顾和荟萃分析。

方法：从开始到2019年11月18日，在Pubmed，EMBASE和Cochrane图书馆中对B型肝炎和PegIFN的研究进行了全面检索。该研究的主要终点是延长疗程结束时的HBsAg丢失率。次要终点是安全性。所有分析均使用R3.6.1版软件进行。通过使用审核管理器5.3对RCT进行质量评估。

结果：总共9项研究（包括545例CHB患者）符合纳入标准。基于PegIFN的持续治疗后合并的HBsAg丢失率是11％（95％CI：0.05-0.19），I2 = 82％，P <0.01（Q检验）。延长疗程是安全且可耐受的。亚组分析显示，HBeAg阳性和HBeAg阴性患者的HBsAg丢失率分别为14％（95％CI：0.04-0.29）和10％（95％CI：0.02-0.20）（P = 0.52）。 PegIFN单药治疗和PegIFN联合Nucleos（t）ide类似物（NAs）治疗的HBsAg丢失率分别为11％（95％CI：0.03-0.22）和12％（95％CI：0.04-0.24）（P = 0.84）。优势组和非优势组的HBsAg丢失率分别为25％（95％CI：0.19-0.31）和8％（95％CI：0.03-0.15）（P = 0.001）。

结论：对于CHB患者，延长基于PegIFNα的治疗时间超过48周可能会提高HBsAg清除率。特别是，有利的群体将受益匪浅。另外，延长疗程是安全且可耐受的。

关键字：慢性乙型肝炎；乙型肝炎表面抗原丢失；荟萃分析；聚乙二醇干扰素；系统评价。

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