Long term effect of alpha interferon in children with chronic hepatitis B

Bortolotti, Flavia; Jara, Paloma; Barbera, Cristiana; Gregorio, Germana V.; Vegnente, Angela; Zancan, Lucia; Hierro, Loreto; Crivellaro, Carlo; Vergani, G; Iorio, Raffaele; Pace, M; Con, P; Gatta, Angelo

doi:10.1136/gut.46.5.715

Cited by 132 publications

(96 citation statements)

References 18 publications

(8 reference statements)

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“…5,[12][13][14][15] Treatment with lamivudine was not associated with any significant side effects. However, to enable pediatricians to be able to use this agent appropriately, it was important to evaluate treatment over a longer duration, and to evaluate the durability of the treatment response obtained.…”

Section: Discussionmentioning

confidence: 99%

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Long-term lamivudine therapy for children with HBeAg-positive chronic hepatitis B

et al. 2006

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C hronic hepatitis B is a significant global health care problem that affects more than 350 million people worldwide, resulting in approximately 1 million deaths each year. 1 Despite the widespread availability of an effective vaccine, large numbers of children are infected. People infected early in life who have evidence of ongoing viral replication are at the highest risk for development of progressive liver disease and are a major source of infection in others. 2 Treatment options for children are limited. The goal of treatment is to prevent the progression of chronic hepatitis B to long-term complications, such as cirrhosis and hepatocellular carcinoma, that can result in premature death. 3 Interferon ␣ has demonstrated efficacy in achieving hepatitis B e antigen (HBeAg) loss and seroconversion with HBV DNA suppression in children over 1 year old with active hepatitis B. However, only one third of treated patients will respond, and there are significant side effects associated with interferon therapy, including influenzalike symptoms, gastrointestinal disorders, nausea and vomiting, neutropenia, thrombocytopenia, and transient impairment of growth. 4,5 Treatment with lamivudine, an oral nucleoside analog, has been shown to result in similar response rates as interferon in both adults and children. [6][7][8][9] The drug is well tolerated, but long-term efficacy can be compromised by the emergence of resistance. 10 Treatment with lamivu-

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Section: Discussionmentioning

confidence: 99%

“…5,[11][12][13][14][15] Treatment with interferon ␣ has the advantage of a finite duration and does not result in the emergence of HBV mutations associated with resistance. On the other hand, interferon ␣ treatment is expensive and is associated with significant side effects, including transient growth impairment.…”

Section: Discussionmentioning

confidence: 99%

Long-term lamivudine therapy for children with HBeAg-positive chronic hepatitis B

et al. 2006

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“…Currently none of the HBV treatments fulfill these conditions. With interferon based therapy HBsAg loss occurs in 3%-10% of the patients within one year of start of therapy and increases in sustained responders to 11%-32% [3][4][5][6][7][8][9] . HBsAg loss is rare (< 2% after one year of treatment) in patients treated with nucleos(t)ide analogues, which is about the rate observed in the natural history of the disease [10][11][12][13][14][15][16] .…”

Section: Naïve Patientsmentioning

confidence: 99%

Future prospectives for the management of chronic hepatitis B

Leemans

Janssen

Man³

2007

WJG

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Chronic hepatitis B virus infection affects about 400 million people around the globe and causes approximately one million deaths a year. Since the discovery of interferon-α as a therapeutic option the treatment of hepatitis B has evolved fast and management has become increasingly complicated. T h e a m o u n t o f v ira l re p l ic a t io n re f le c t e d in t he viral load (HBV-DNA) plays an important role in the development of cirrhosis and hepatocellular carcinoma. The current treatment modalities for chronic hepatitis B are immunomodulatory (interferons) and antiviral suppressants (nucleoside and nucleotide analogues) all with their own advantages and limitations. An overview of the treatment efficacy for both immunomodulatory as antiviral compounds is provided in order to provide the clinician insight into the factors influencing treatment outcome. With nucleoside or nucleotide analogues suppression of viral replication by 5-7 log10 is feasible, but not all patients respond to therapy. Known factors influencing treatment outcome are viral load, ALT levels and compliance. Many other factors which might influence treatment are scarcely investigated. Identifying the factors associated with response might result in stopping rules, so treatment could be adapted in an early stage to provide adequate treatment and avoid the development of resistance. The efficacy of compounds for the treatment of mutant virus and the crossresistance is largely unknown. However, genotypic and phenotypic testing as well as small clinical trials provided some data on efficacy in this population. Discontinuation of nucleoside or nucleotide analogues frequently results in viral relapse; however, some patients have a sustained response. Data on the risk factors for relapse are necessary in order to determine when treatment can be discontinued safely. In conclusion: chronic hepatitis B has become a treatable disease; however, much research is needed to tailor therapy to an individual patient, to predict the sustainability of response and determine the best treatment for those failing treatment.

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“…Rates of HBsAg loss have been reported in 5-10% of European patients during 1 year of treatment, increasing to 11-25% among sustained responders over a 5-year follow-up period [20,23,25,26]. Long-term follow-up of a group of HBeAg-positive patients who responded to IFN suggested that the remissions induced are of long duration and were followed in most cases by loss of HBsAg and lack of evidence of HBV replication [27].…”

Section: Conventional Interferonmentioning

confidence: 99%

Chronic hepatitis B: a global health problem requiring coherent worldwide treatment strategies

2007

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Chronic hepatitis B virus infection, a major cause of end-stage liver disease and hepatocellular carcinoma, is a worldwide health concern. While the past two decades have brought major advances in the availability of treatments to help delay or prevent these outcomes, treatment of chronic hepatitis B remains a serious challenge, not least due to the ability of the virus to remain in hepatocyte nuclei as a source of potential reactivation-hence the term chronic hepatitis B infection. This article reviews the current treatments available and suggests a framework for a rational approach to managing the disease.

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Long term effect of alpha interferon in children with chronic hepatitis B

Cited by 132 publications

References 18 publications

Long-term lamivudine therapy for children with HBeAg-positive chronic hepatitis B

Long-term lamivudine therapy for children with HBeAg-positive chronic hepatitis B

Future prospectives for the management of chronic hepatitis B

Chronic hepatitis B: a global health problem requiring coherent worldwide treatment strategies

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