Interferon alpha treatment leads to a high rate of hepatitis B surface antigen seroconversion in Chinese children with chronic hepatitis B

et al. 2022

Preprint

Background and objectives: Pegylated interferon (peg-IFN) and entecavir (ETV) are both recommended as the first-line antiviral drugs for chronic hepatitis B (CHB) at present. We aimed to compare the efficacy and safety between peg-IFN and ETV initial therapy in children and adolescents with CHB and investigate the potential factors affecting the treatment response during the first 48 weeks. Methods: We retrospectively enrolled 70 treatment-naïve children and adolescents with CHB who received peg-IFN(n=26) or ETV(n=44) as initial therapy and completed 48-week follow-up for data analysis. Blood samples before treatment were collected from 26 patients of the cohort to assess the cytokine profiles. Results: We found that initial peg-IFN therapy results in higher rates of hepatitis B surface antigen (HBsAg) serological response (SR) but lower rates of virological and biochemical response rates compared to ETV at week 48. As for achieving hepatitis B envelope antigen (HBeAg) SR, peg-IFN was comparable to ETV in the univariate analysis and turned out to be better than ETV after adjustment for important baseline factors. We also found that elevated pre-treatment IL-18 level was significantly associated with HBeAg SR, and remained as the only independent factor of predicting HBeAg SR after adjustment for other important factors. No serious adverse effects of the 2 drugs were reported during the 48-week follow-up. Conclusions: comparing to ETV, peg-IFN was superior in achieving HBsAg and HBeAg SR; higher baseline IL-18 levels were independently associated with HBeAg SR in this study of children and adolescents with CHB.

Section: Discussionsupporting

confidence: 84%

The efficacy of pegylated interferon and entecavir in HBeAg-positive children and adolescents with chronic hepatitis B

Zhou

et al. 2022

Preprint

“…Our findings confirmed a relatively high HBsAg loss rate of 36.4% (4/11) in the IFN‐based therapy group after a median follow‐up of 28.0 months. The rate falls into the reported ranges of 8.9%–83% with IFN‐based therapy after a maximum follow‐up of 13 years 12–14,26,27 . Whereas the effects of NAs are less studied.…”

Section: Discussionmentioning

confidence: 89%

Frequent alanine aminotransferase flares and promising antiviral therapy efficacy during the preschool age: An opportunity to achieve HBsAg loss in children with mother‐to‐child transmitted hepatitis B

Yao

Journal of Viral Hepatitis

et al. 2022

Alanine aminotransferase (ALT) flare remains one of the determinants of initiating antiviral therapy in children with chronic hepatitis B (CHB). Insufficient data exist regarding children with CHB attributed to mother‐to‐child transmission. This study aimed to assess the occurrence of spontaneous ALT flares and identify factors affecting therapy‐induced hepatitis B surface antigen (HBsAg) loss in the flare cohort. We retrospectively included untreated children with mother‐to‐child transmitted CHB. The primary outcomes were spontaneous ALT flares and therapy‐induced HBsAg loss. Among 83 untreated children, 73.5% (61/83) experienced spontaneous ALT flares during the median follow‐up of 14.6 months (range, 0.1–177.1 months), with 54.1% of the first ALT flares and 44.3% of ALT peaks occurring within 6 years of age. Thirty‐six of 61 children with ALT flares received antiviral therapy, nine (25.0%) of whom achieved therapy‐induced HBsAg loss with a median duration of 19.3 months (range, 6.5–56.2 months). The age of initiation of antiviral therapy was the sole predictor of therapy‐induced HBsAg loss (HR = 0.544, 95% CI 0.353–0.838, p = 0.006). The restricted cubic spline showed a negative relationship between the age of initiation of antiviral therapy and HBsAg loss and identified that 6.2 years of age discriminated children with therapy‐induced HBsAg loss. Kaplan–Meier estimations suggested a higher probability of HBsAg loss in children who started antiviral therapy before 6.2 years old (p = 0.03). In conclusion, asymptomatic ALT flares were frequent in preschool‐aged children with mother‐to‐child transmitted CHB, and early initiation of antiviral therapy showed promising effects in those children with ALT flares.

“…In our study, lower HBsAg levels at baseline were positively associated with both HBeAg and HBsAg SR, which similarly indicated the value of quantitative HBsAg in guiding antiviral therapy in CHB children and adolescents. Moreover, younger age(< 6 years) was also a favourable factor for both HBeAg and HBsAg SR. Studies have reported that children and adolescents, especially younger children, seemed to have higher rates of SR than adults [ 24 – 26 ], which is possibly due to the relatively short incubation time of HBV and the less exhausted HBV-specific immune response of the host [ 27 , 28 ]. A higher level of ALT was an independent favourable factor for HBeAg SR, which was also in line with previous studies [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

The efficacy of pegylated interferon alpha-2a and entecavir in HBeAg-positive children and adolescents with chronic hepatitis B

Zhou

et al. 2022

BMC Pediatr

Background and objectives Pegylated interferon alpha-2a (peg-IFN α-2a) and entecavir (ETV) are both recommended as the first-line antiviral drugs for chronic hepatitis B (CHB) at present. We aimed to compare the efficacy and safety between peg-IFN α-2a and ETV initial therapy in children and adolescents with CHB and investigate the potential factors affecting the treatment response during the first 48 weeks. Methods We retrospectively selected 70 treatment-naïve children and adolescents with CHB who received peg-IFN α-2a(n = 26) or ETV(n = 44) as initial therapy and completed 48-week follow-up for data analysis. Blood samples before treatment were collected from 26 patients of the cohort to assess the cytokine profiles. Results We found that initial peg-IFN therapy results in higher rates of hepatitis B surface antigen (HBsAg) serological response (SR) but lower rates of virological and biochemical response rates compared to ETV at week 48. As for achieving hepatitis B e antigen (HBeAg) SR, peg-IFN was comparable to ETV in the univariate analysis and turned out to be better than ETV after adjustment for important baseline factors. We also found that elevated pre-treatment IL-18 level was significantly associated with HBeAg SR, and remained as the only independent factor of predicting HBeAg SR after adjustment for other important factors. No serious adverse effects of the 2 drugs were reported during the 48-week follow-up. Conclusions comparing to ETV, peg-IFN was superior in achieving HBsAg and HBeAg SR; higher baseline IL-18 levels were independently associated with HBeAg SR in this study of children and adolescents with CHB.