干扰素和核苷类似物联合治疗对慢性乙型肝炎功能治愈的影

StephenW

Effect of combination treatment based on interferon and nucleos(t)ide analogues on functional cure of chronic hepatitis B: a systematic review and meta-analysis
Jiaye Liu  1   2 , Tingyan Wang  3 , Wei Zhang  2   4 , Yongqian Cheng  2 , Qing He  1 , Fu-Sheng Wang  5
Affiliations
Affiliations

    1
    Institute of Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, 518112, Guangdong, China.
    2
    Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
    3
    Nuffield Department of Medicine, University of Oxford, Oxford, UK.
    4
    Diagnosis and Treatment Center for Liver Disease, The 960Th Hospital of Chinese PLA Joint Logistics Support Force, Tai'an, 271000, Shandong, China.
    5
    Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China. [email protected].

    PMID: 33185803 DOI: 10.1007/s12072-020-10099-x

Abstract

Background: Priority of antiviral treatment for patients with chronic hepatitis B (CHB) is to increase the probability of functional cure. We aimed to synthesize evidence regarding the efficacy of different combination strategies of antiviral treatment based on interferon (IFN) and nucleos(t)ide analogues (NAs) in adults with CHB.

Methods: PubMed, Web of Science and Embase databases were searched from inception to May 26, 2019. Three types of combination strategies were studied: initial combination (IFN or NAs monotherapy as control), add-on (I: IFN add-on NAs vs. NAs; II: NAs add-on IFN vs. IFN), switch-to (I: IFN switch-to NAs vs. IFN; II: NAs switch-to IFN vs. NAs).

Results: Compared to NAs monotherapy, initial combination strategy improved the probability of HBeAg loss (RR: 1.62, 95% CI 1.33-1.97) and HBsAg loss (RR: 15.59, 95% CI 3.22-75.49), while compared to IFN monotherapy, no higher rates in the loss of HBsAg or HBeAg for initial combination. Compared to NAs monotherapy, IFN add-on NAs strategy had a higher rate of HBsAg loss (RR: 4.52, 95% CI 1.95-10.47), while compared to IFN monotherapy, NAs add-on IFN had a similar outcome. Compared to NAs monotherapy, NAs switch-to IFN strategy improved HBsAg loss (RR: 12.15, 95% CI 3.99-37.01); while compared to IFN monotherapy, IFN switch-to NAs had no improved rate of HBsAg clearance but higher rates in undetectable HBV DNA, and HBeAg loss.

Conclusion: IFN add-on NAs, or NAs switched to IFN could significantly improve the probability of HBsAg loss compared to NAs monotherapy.

Keywords: Chronic hepatitis B; Combination treatment strategies; HBsAg loss; Interferon; Nucleos(t)ide analogues.

StephenW

干扰素和核苷类似物联合治疗对慢性乙型肝炎功能治愈的影响：系统评价和荟萃分析
刘佳业1 2，王廷彦3，张伟2 4，成永谦2，清河1，王福生5
隶属关系
隶属关系

    1个
    深圳市第三人民医院国家传染病临床研究中心肝病研究所，广东深圳518112
    2
    中国人民解放军总医院第五医学中心传染病治疗研究中心，北京。
    3
    英国牛津牛津大学纳菲尔德分校医学系。
    4
    中国人民解放军联合后勤保障部队第960医院肝病诊治中心，山东泰安271000。
    5
    中国人民解放军总医院第五医学中心传染病治疗研究中心，北京。 [email protected]。

    PMID：33185803 DOI：10.1007 / s12072-020-10099-x

抽象

背景：慢性乙型肝炎（CHB）患者应优先接受抗病毒治疗，以增加功能治愈的可能性。我们旨在合成证据，证明有关基于干扰素（IFN）和核苷酸（t）ide类似物（NAs）的成人CHB患者抗病毒治疗不同联合策略的疗效。

方法：从成立至2019年5月26日，搜索PubMed，Web of Science和Embase数据库。研究了三种类型的联合策略：初始联合（IFN或NAs单药作为对照），附加药物（I：IFN附加NAs） vs.NAs； II：NAs附加IFN vs.IFN），切换至（I：IFNs切换至NAs vs.IFN； II：NAs切换至IFN vs.NAs）。

结果：与NAs单一疗法相比，初始联合策略可提高HBeAg丧失（RR：1.62，95％CI 1.33-1.97）和HBsAg丧失（RR：15.59，95％CI 3.22-75.49）的可能性，与IFN单一疗法相比，初次联合使用时，HBsAg或HBeAg的流失率没有更高的比率。与NAs单药治疗相比，添加IFN的NAs策略具有更高的HBsAg丢失率（RR：4.52，95％CI 1.95-10.47），而与IFN单药治疗相比，添加NAs的IFNs具有相似的结果。与NAs单一疗法相比，NAs切换至IFN策略可改善HBsAg丢失（RR：12.15，95％CI 3.99-37.01）；与IFN单药治疗相比，IFN转换为NAs并没有改善HBsAg清除率，但是在未检测到的HBV DNA和HBeAg丢失率更高。

结论：与NAs单药治疗相比，添加IFN的NAs或将NAs转换为IFN可以显着提高HBsAg丢失的可能性。

关键字：慢性乙型肝炎；联合治疗策略； HBsAg丢失；干扰素核苷类似物。