Abstract :
Background: Treatment of chronic hepatitis B (CHB), HBeAg positive patients includes pegylated
interferon (PegIFN) or nucleos(t)ide analogues (NUC). However, about two-thirds of patients treated with PegIFN
do not achieve HBeAg seroconversion and may require treatment with NUC. So far, there are few data about
outcomes of CHB patients treated with PegIFN followed by NUC. Whether pre-treatment with PegIFN offers more
HBeAg seroconversion remains uncertain. The objective of this study was to investigate the outcome of patients
pre-treated with PegIFN followed by entecavir compared with patients treated with entecavir alone.
Methods: This is a retrospective chart review from January 2005 to July 2012. There were 46 patients
pre-treated with PegIFN alfa-2a for 48 weeks, who did not achieve HBeAg seroconversion and required treatment
with entecavir (0.5mg) daily, compared with 50 patients treated with entecavir alone during the same period. HBeAg
status and HBV DNA level at baseline and every 1 year after starting entecavir were collected and compared
between the two groups.
Results: The PegIFN/entecavir group was younger (mean age 45.4 vs. 52.3 years, p=0.004) and had
less advanced fibrosis/cirrhosis at baseline (8.9% vs. 35.4%, p=0.002) than in the entecavir group. Furthermore, the
entecavir treatment duration was shorter in the PegIFN/entecavir group (116.8 vs. 162.5 weeks, p=0.004). After 1
year of entecavir treatment, there was no significant difference in the rates of HBeAg seroconversion, HBeAg loss,
and undetectable HBV DNA in both groups (10.9% vs. 14.0%, p=0.643; 7.3% vs. 4.6%, p=0.669 and 54.3% vs.
64.0%, p=0.336; respectively). These outcomes were also not different between the two groups at year-2 through
year-5 after entecavir treatment.
Conclusion: In HBeAg-positive CHB patients, pre-treatment with PegIFN alfa-2a before entecavir did
not increase HBeAg seroconversion, HBeAg loss or HBV DNA suppression, when compared to patients treated
with entecavir alone. |
file/Thai-Journal-of-gastroenterology-vol-14-no-3-2390384.pdf