Response-guided peginterferon therapy in patients with HBeAg-positive chronic hepatitis B: A randomized controlled study

Jian Suna, Hong Maa, Qing Xie, Yao Xie, Yongtao Sun, Hao Wang, Guangfeng Shi, Mobin Wan, Junqi Niu, Qin Ning, Yanyan Yu, Huijuan Zhou, Jun Cheng, Wenzhen Kang, Yi Xie, Rong Fan, Lai Wei, Hui Zhuang, Jidong Jia, Jinlin Hou

Abstract

Background & Aims

Response-guided therapy has been confirmed to be an effective strategy for the treatment of chronic hepatitis C in the peginterferon (PegIFN) era, but no randomized trial utilizing this strategy has been conducted in chronic hepatitis B.

Methods

In this open-label, multicenter, randomized trial, HBeAg positive patients were treated with PegIFN (180 μg/week) for 24 weeks. Early responders (HBsAg <1500 IU/mL and HBV DNA <105 copies/mL at week 24) received PegIFN for a further 24 weeks (Arm A), while non-early responders were randomized to PegIFN for another 24 weeks (Arm B), another 72 weeks (Arm C) or PegIFN for another 72 weeks plus adefovir for 36 weeks (Arm D). The primary endpoint was the change of quantitative HBsAg from baseline to the end of follow-up (EOF).

Results

For non-early responders, 96-week PegIFN monotherapy did not lead to a greater reduction of HBsAg from baseline to EOF, compared with 48-week PegIFN (-0.71 vs -0.67 log10 IU/mL, P=0.407). The rate of HBeAg seroconversion with HBV DNA <2000 IU/ml at EOF were similar for Arms B, C and D (17.9%, 23.9% and 25.0% respectively). For patients with HBsAg <1500 IU/ml or HBV DNA <105 copies/ml at week 24, 38.4% and 37.0% achieved HBeAg seroconversion with HBV DNA <2000 IU/ml at EOF respectively.

Conclusions

Patients with HBsAg <1500 IU/ml or HBV DNA <105 copies/ml at week 24 would benefit from continued PegIFN treatment. Extending the duration of PegIFN with or without adding adefovir did not show superiority over 48 weeks PegIFN monotherapy.

Lay summary

Extending the duration of pegylated interferon (PegIFN) alfa-2a is not recommended in HBeAg positive patients as treatment extension beyond 48 weeks did not show convincing benefit.

Patients who achieved HBsAg <1500 IU/ml or HBV DNA <105 copies/ml after 24-week PegIFN alfa-2a showed satisfactory outcome after the withdrawal of finite PegIFN alfa-2a treatment.