Potent hepatitis B surface antigen response to treatment of hepatitis‐B‐e‐antigen‐positive chronic hepatitis B with α‐interferon plus a nucleos(t)ide analog

Background and Aim:  Hepatitis B surface antigen (HBsAg) clearance is the closest cure outcome in hepatitis B. The goal of this study was to investigate clinical features in chronic hepatitis B patients achieving seroconversion of HBsAg after treatment with α‐interferon (IFN‐α) and a nucleos(t)ide analog. Methods:  This retrospective study enrolled 38 chronic hepatitis B patients treated with IFN‐α plus a nucleos(t)ide analog who achieved HBsAg seroconversion during the period from June 2001 to May 2009. Clinical and laboratory data of the patients were collected before and after treatment every 3 months. All patients with HBsAg seroconversion in this study were followed up for at least 12 months post‐treatment. Results:  A total of 38 out of 142 patients achieved HBsAg seroconversion after treatment with IFN‐α and a nucleos(t)tide analog for a prolonged period of time (medium 31 months). The median time to hepatitis B e antigen seroconversion and to HBsAg seroconversion was 19.5 months (range 3–60 months) and 25.5 months (range 9–63 months), respectively. Thirty‐six patients (95%) sustained HBsAg seroconversion during the post‐treatment follow up. Three different HBsAg response patterns were observed with classical model accounting for 57.9% (22/38 cases), simultaneous transition mode accounting for 23.7% (9/38 cases), and HBsAg prior transition model accounting for 18.4% (7/38 cases). Conclusions:  Extended treatment with IFN‐α in combination with a nucleos(t)ide analog in patients with hepatitis‐B‐e‐antigen‐positive appears to be a promising approach for achieving a high rate of HBsAg clearance—the closest outcome to cure.