The role of peginterferon in nucleos(t)ide‐analogue‐treated chronic hepatitis B patients: A review of published literature

Abstract

Chronic hepatitis B infection (CHB) causes up to 1.0 million deaths annually. Currently, more than 90% of CHB patients worldwide are receiving indefinite nucleos(t)ide analogue (NA) therapy. New strategies for optimizing hepatitis B surface antigen (HBsAg) loss are required for NA-treated patients as the majority are unable to achieve HBsAg loss and may require lifelong therapy. In hepatitis B e antigen (HBeAg)-positive patients, switching from NAs to finite peginterferon (PegIFN) therapy can double HBeAg seroconversion rates. One in five patients who switch to PegIFN can achieve HBsAg loss, whereas patients who continue NA therapy typically do not. In HBeAg-negative NA-treated patients, add-on PegIFN therapy achieves higher, albeit modest, HBsAg loss rates compared with continued NA monotherapy and offers the opportunity for NA-treated patients to achieve the inactive carrier state. In the absence of curative therapies, PegIFN represents a valuable, finite option for NA-treated patients who would otherwise require potentially lifelong therapy.

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

“…Indeed, <5% of adult patients with CHB show cleared HBsAg after IFNa treatment, whereas over 50% of the children treated with PEG‐IFNa in our study achieved a functional cure. Generation of protective HBsAb is also rarely achieved in CHB adults and is therefore scarcely documented ; however, nearly half of the IFNa‐treated patients in our cohort generated a protective level of HBsAb. Overall, these results demonstrated a high level of status changes of HBV DNA, HBeAg, HBsAg and HBsAb in PEG‐IFNa‐treated individuals, indicating that children and adolescents with CHB are more responsive to PEG‐IFNa treatment to achieve a functional cure.…”

Serum HBV RNA as a Predictor of Peginterferon Alfa-2a Response in Patients With HBeAg-Positive Chronic Hepatitis B

“…Accordingly, a strong correlation between serum HBV RNA and cccDNA during treatment with NAs as well as with PegIFN alfa-2a was demonstrated in a recent study by Giersch et al [20]. Thus, serum HBV RNA may represent a reliable serum marker for cccDNA activity, and monitoring of serum HBV RNA levels may be a useful additional marker, particularly for future treatments aimed at cccDNA eradication [12].…”

“…While several treatment-stopping rules and responseguided therapy algorithms have been proposed [11], their main limitation is the relatively small proportion of nonresponders (approximately 20%) that are accurately identified [7,8]. Thus, exploration of novel response-predicting biomarkers is needed in order to improve the efficacy of PegIFN alfa treatment [12].…”

KASL clinical practice guidelines for management of chronic hepatitis B

“…Several randomized controlled trials reported 4–9.8% HBsAg seroclearance rates when NA was changed to 48-week peginterferon alfa treatment with/without maintaining NA [358-362]. In addition, 96-week peginterferon alfa treatment increased the HBsAg seroclearance rate to 15.3%.…”