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Switching to peginterferon for chronic hepatitis B patients with hepatitis B e antigen seroconversion on entecavir – A prospective study
Author(s) -
Chan Henry L. Y.,
Chan Fiona W. S.,
Hui Aric J.,
Li Michael K. K.,
Chan Kam H.,
Wong Grace L. H.,
Loo Ching K.,
Chim Angel M. L.,
Tse Chi H.,
Wong Vincent W. S.
Publication year - 2019
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.13000
Subject(s) - hbsag , medicine , hbeag , seroconversion , entecavir , gastroenterology , hepatitis b virus , hepatitis b , clinical endpoint , immunology , virus , lamivudine , clinical trial
Summary Nucleos(t)ide analogues ( NA ) are effective in suppressing hepatitis B virus ( HBV ) replication, but most patients require long‐term treatment. This study aimed to investigate switching to peginterferon as a strategy to stop NA . Hepatitis B e antigen ( HB eAg)‐positive chronic hepatitis B patients who developed HB eAg seroconversion during NA treatment were studied. All patients received open‐label peginterferon alfa‐2a 180 μg/wk for 48 weeks, and NA was stopped at week 4 of peginterferon treatment. The primary endpoint was sustained response, which was defined as negative HB eAg, positive anti‐ HB e and HBV DNA <2000 IU/mL at week 72. Other secondary endpoints including HB sAg loss at week 72 were also studied. Forty‐one patients treated with entecavir for 56 ± 23 months were recruited. Sustained response was achieved in 30 patients (73%, 95% confidence interval 58%‐84%). At week 72, 31 (76%) patients had HB eAg seroconversion, 56 (23%) patients had undetectable HBV DNA , 31 (76%) patients had normal ALT , and 6 patients (15%) had HB sAg loss. Baseline HB sAg level was the best predictor for both sustained response and HB sAg loss; the best HB sAg cut‐off for sustained response was <1500 IU/mL and that for HBsAg loss was <500 IU/mL by receiver operating characteristic curve analysis. Twenty‐two of 25 (88%) patients with baseline HBsAg <1500 IU/mL had sustained response. Five of 10 (50%) patients with baseline HBsAg <500 IU/mL developed HB sAg loss. Switching to peginterferon can be considered as a treatment option in NA ‐treated patients with HB eAg seroconversion, particularly among those with lower HB sAg levels.