A randomized, controlled trial of interferon alfa-2b alone and with simultaneous prednisone for the treatment of chronic hepatitis B

Zarski, Jean–Pierre; Causse, Xavier; Cohard, Marielle; Cougnard, Jean; Trépo, Christian

doi:10.1016/s0168-8278(05)80143-6

Cited by 16 publications

(5 citation statements)

References 17 publications

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“…However, a conclusive positive impact of antiviral drugs on all intermediate parameters has not been shown. In addition, there is a lack of consensus about the modulation of clinical outcomes by antiviral therapy in chronic hepatitis B [11][12][13][14][15][16][17]. The Minnesota Evidence-based Practice Center (EPC) for a National Institutes of Health (NIH) Consensus Conference related to the management of chronic hepatitis B analyzed different RCTs of antiviral therapy in chronic hepatitis B [24].…”

Section: Ongoing Regimens Of Antiviral Therapy Against Chronic Hepatimentioning

confidence: 99%

“…In addition, there is a lack of consensus regarding improvement of the clinical outcome in chronic hepatitis B patients using antiviral drugs. Some studies have reported some beneficial effects, whereas others have not shown significant improvement of clinical outcomes with antiviral drugs [11][12][13][14][15][16][17]. Furthermore, concerns have been raised about the different surrogate markers of outcome of antiviral therapy for chronic hepatitis B that have been used to assess the therapeutic efficacy of the antiviral drugs.…”

Section: Introductionmentioning

confidence: 99%

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Future aspects of therapy for hepatitis B virus infection: value of surrogate markers, innovative therapy, and global collaboration

2011

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Both optimism and frustration exist regarding therapy for patients with chronic hepatitis B virus infection. Due to the recent advent of several drugs with potent antiviral capacities and comparatively low rates of adverse effects, considerable optimism has developed regarding the treatment of these patients. Chronic hepatitis B is now a treatable disease, and suppression of hepatitis B virus replication, normalization of alanine aminotransferase levels, seronegativity/seroconversion of hepatitis B e antigen and hepatitis B surface antigen, and decreased hepatic inflammation and liver fibrosis have been documented in chronic hepatitis B virus-infected patients treated with antiviral therapy. In contrast, many frustrations regarding antiviral therapy for chronic hepatitis B have arisen, because the disease, although treatable, is not curable. The present regimens of antiviral therapy modulate some intermediate parameters or so-called surrogate markers in chronic hepatitis B virus-infected patients, but usually fail to improve all intermediate parameters or ultimate clinical outcomes. In addition, major concerns remain about the applicability and use of antiviral drugs in developing and resource-constrained countries in which healthcare delivery systems do not support the proper use of antiviral therapy. New and more effective therapeutic regimens for chronic hepatitis B patients are needed that take into account potential surrogate markers of treatment outcomes and allow for effective collaboration between resource-constrained and advanced countries.

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Section: Ongoing Regimens Of Antiviral Therapy Against Chronic Hepatimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Future aspects of therapy for hepatitis B virus infection: value of surrogate markers, innovative therapy, and global collaboration

2011

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“…One patient who stopped his initial treatment, relapsed and died of cerebral infarction and there was a favourable outcome in a second on a regimen of initial corticosteroids, lamivudine and plasma exchanges 21 . Steroids appear to have a priming effect in HBV treatment as studies have shown that the virologic response to lamivudine and interferon in chronic HBV infection is enhanced by a prior course of corticosteroids which is not seen if steroids and anti-viral drugs are initiated together 22 . It has been proposed that traditional immunosuppression with cytotoxic drugs and prolonged steroids should no longer be used in HBVrelated PAN given that plasma exchange with antiviral drugs and an initial short course of steroids appears to be a successful treatment 6 .…”

Section: Treatment Of Hbv-related Panmentioning

confidence: 99%

Treatment of Hepatitis B related Polyarteritis Nodosa presenting with mononeuritis multiplex

Reid¹,

Coleman²

2006

Scott Med J

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We describe the case of a male patient who presented with mononeuritis multiplex due to polyarteritis nodosa following recent hepatitis B infection. Despite immunomodulatory treatment, the condition progressed with renal and small bowel involvement and the patient died. This case illustrates the difficulty in treating this multisystem disorder and we review the literature on its pathogenesis and treatment. Case ReportA 58 year-old man presented to his GP with symptoms of tingling in his hands that resolved over 3 days. Blood tests showed elevated liver enzymes and hepatitis screening that showed him to be hepatitis B virus (HBV) positive. He was homosexual but denied unprotected sexual contact for several years. There was no history of blood transfusion or injecting any drugs. One month later he developed pins and needles initially in the toes of his left foot which then affected the right foot and progressed to the calves. His ankles were weak and he tended to trip. He had lost 2 stone in weight. He did not drink alcohol and took no medications. When seen for neurological assessment he was thin, had bilateral ankle oedema, and BP was 150/90. He had left ankle dorsiflexion weakness and bilateral plantiflexion weakness. Both ankle jerks were absent. Pinprick sensation was reduced on the soles of both feet and the dorsum of the left foot. He had absent vibration sense from the ankles distally. These findings were consistent with a right common peroneal and bilateral tibial neuropathies. Nerve conduction studies showed evidence of a lower limb neuropathy. CSF examination was acellular, with normal protein and glucose; oligocloncal bands were absent. An

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“…Prednisone pretreatment is intended to enhance the response to interferon, particularly in patients with normal or near normal ALT. Controlled trials have demonstrated that there is a small additional benefit from prednisone pretreatment (3,4). However, occasional deaths have been reported due to a severe flare of active hepatitis.…”

Section: Prednisone Pretreatmentmentioning

confidence: 99%

Management of Viral Hepatitis: Clinical and Public Health Perspectives – A Consensus Statement

Sherman

1997

Canadian Journal of Gastroenterology

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The Canadian Liver Foundation convened a two-day conference in September 1996, at which experts from across Canada were invited to discuss various aspects of viral hepatitis and to issue guidelines to assist practitioners in caring for patients with these diseases. The proceedings of this conference were transcribed and submitted to all participants for approval before being submitted for publication. The views expressed in this article represent the consensus opinion of the group. Where there was significant difference of opinion this is explicitly stated, and opposing points of view are given.

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A randomized, controlled trial of interferon alfa-2b alone and with simultaneous prednisone for the treatment of chronic hepatitis B

Cited by 16 publications

References 17 publications

Future aspects of therapy for hepatitis B virus infection: value of surrogate markers, innovative therapy, and global collaboration

Future aspects of therapy for hepatitis B virus infection: value of surrogate markers, innovative therapy, and global collaboration

Treatment of Hepatitis B related Polyarteritis Nodosa presenting with mononeuritis multiplex

Management of Viral Hepatitis: Clinical and Public Health Perspectives – A Consensus Statement

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