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Therapeutic vaccination for chronic hepatitis B: A systematic review and meta‐analysis
Author(s) -
Lim Seng Gee,
Agcaoili Jennielyn,
De Souza Nurun Nisa Amatullah,
Chan Edwin
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.13085
Subject(s) - medicine , therapeutic effect , hepatitis b , vaccination , hepatitis b virus , randomized controlled trial , meta analysis , seroconversion , immunology , virus
Summary Therapeutic vaccines may be promising treatments for chronic hepatitis B ( CHB ), but their clinical efficacy and safety are unclear. We conducted a systematic review of the evidence for the efficacy and safety of therapeutic vaccines in CHB patients. We searched PubMed, EMBASE and Google Scholar from 1990 until present and abstracts from EASL , APASL and AASLD from 2012 to 2017 and selected randomized controlled trials of CHB patients, comparing therapeutic vaccines with no treatment or standard of care. The Cochrane Risk of Bias tool v2.0 and GRADE method were used. Analyses were stratified by hepatitis B e antigen ( HB eAg) status and the comparator (therapeutic vaccines vs no treatment, or therapeutic vaccines + standard of care vs standard of care). Efficacy outcomes were HB eAg seroconversion, hepatitis B virus DNA reduction and hepatitis B virus surface antigen ( HB sAg) loss, measured at the end of treatment or end of follow‐up. Effects were reported as risk differences with 95% confidence intervals using a random effects model. Fifteen studies were included. A wide variety of therapeutic vaccines were tested. For HBeAg clearance at the end of follow‐up, when comparing therapeutic vaccines vs no therapy, RD = 0.01, 95% CI −0.05 to 0.07, and when comparing therapeutic vaccines + standard of care vs standard of care, RD = 0.03, 95% CI −0.03 to 0.09. For HBVDNA reduction at the end of follow‐up, when comparing therapeutic vaccines vs no therapy, RD = −0.03, 95% CI −0.08 to 0.02, and when comparing therapeutic vaccines + standard of care, RD = 0.15, 95% CI 0.02‐0.28. There were only a few studies on HB sAg loss, and hence, the findings were inconclusive. The only efficacy finding was HBVDNA reduction at the end of follow‐up for therapeutic vaccines + standard of care vs standard of care; otherwise, therapeutic vaccines do not appear to be efficacious for the treatment of CHB , but were limited by few RCT s, suboptimal therapeutic vaccines and patient selection.