Systematic review with meta‐analysis: combination treatment of regimens based on pegylated interferon for chronic hepatitis B focusing on hepatitis B surface antigen clearance

• Published in: Alimentary pharmacology & therapeutics Vol. 47; no. 10; pp. 1340 - 1348
• Main Authors: Qiu, K., Liu, B., Li, S.‐Y., Li, H., Chen, Z.‐W., Luo, A.‐R., Peng, M.‐L., Ren, H., Hu, P.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-05-2018
• Subjects: Antigens; Antiviral Agents - therapeutic use; Hepatitis; Hepatitis B; Hepatitis B e Antigens - immunology; Hepatitis B surface antigen; Hepatitis B Surface Antigens - blood; Hepatitis B Surface Antigens - immunology; Hepatitis B virus - immunology; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - drug therapy; Humans; Interferon; Interferons - therapeutic use; Meta-analysis; Patients; Strategy; Treatment Outcome
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.14629

Summary
Background
The seroclearance of hepatitis B surface antigen (HBsAg) in patients with chronic hepatitis B (CHB) is considered to be associated with favourable clinical outcomes.
Aims
This meta‐analysis was performed to establish the proportion of HBsAg loss rates among CHB patients who received combination treatment based on pegylated interferon (PegIFN). Four combination strategies have been studied with the aim of improving HBsAg loss: “de novo,” “NA‐experienced,” “switch‐to” and “add‐on.” This meta‐analysis was performed to determine which, if any, of these combination strategies was more effective.
Methods
Medline, Web of Science and Embase databases were searched from inception to December 2017. The proportion of patients who achieved HBsAg loss after combination therapy was pooled using a random‐effects model.
Results
Twenty‐four studies fulfilled the meta‐analysis criteria. The overall pooled proportion suggested that the rate of HBsAg loss could be increased to 9% (95% CI: 7%‐12%) based on the combination treatment in CHB patients. Compared with “de novo” strategy (8%, 95% CI: 6%‐10%), the “nucleos(t)ide analogues‐experienced” (11%, 95% CI: 8%‐15%) was found to be more likely (P = 0.036) to achieve a response. Compared with the “add‐on” strategy (8%, 95% CI: 5%‐13%), the “switch‐to” (14%, 95% CI: 9%‐20%) was found to be more likely (P = 0.012) to achieve HBsAg loss.
Conclusion
The “nucleos(t)ide analogues‐experienced” strategy was more effective than the “De novo” strategy in achieving HBsAg loss for CHB patients. Combination treatment using regimens based on Peg‐IFN may be useful to help nucleos(t)ide analogues‐treated patients, who have experienced at least 48 weeks of nucleot(s)ide analogue, achieve HBsAg seroclearance.
Linked ContentThis article is linked to Nhu and Pockros paper. To view this article visit https://doi.org/10.1111/apt.14683.