HBsAg seroclearance or seroconversion induced by peg-interferon alpha and lamivudine or adefovir combination therapy in chronic hepatitis B treatment: a meta-analysis and systematic review

Abstract

Background and aims: Seroclearance or seroconversion of hepatitis B surface antigen (HBsAg) is generally considered as a clinical endpoint. The purpose of the present meta-analysis was to evaluate the effect of combined therapy with pegylated interferon alpha (PEG-IFNα) with or without lamivudine (LAM) or adefovir (ADV) on HBsAg seroclearance or seroconversion in subjects with chronic hepatitis B (CHB).Methods: Randomized controlled trials performed through May 30 th 2015 in adults with CHB receiving PEG-IFNα and LAM or ADV combination therapy or monotherapy for 48-52 weeks were included. The Review Manager Software 5.2.0 was used for the meta-analysis.Results: No statistical differences in HBsAg seroclearance (9.9% vs. 7.1%, OR = 1.47, 95% CI: 0.75, 2.90; p = 0.26) or HBsAg seroconversion (4.2% vs. 3.7%, OR = 1.17, 95% CI: 0.57, 2.37; p = 0.67) rates were noticed between PEG-IFNα + LAM and PEG-IFN α + placebo during post-treatment follow-up for 24-26-weeks in subjects with hepatitis Be antigen (HBeAg)-positive CHB.No statistical differences in HBsAg clearance (10.5% vs. 6.4%, OR = 1.68, 95% CI: 0.75, 3.76; p = 0.21) were seen, but statistical differences in HBsAg seroconversion (6.3% vs. 0%, OR = 7.22, 95% CI: 1.23, 42.40; p = 0.03) were observed, between PEG-IFNα + ADV and PEG-IFNα for 48-52 weeks of treatment in subjects with HBeAg-positive CHB.A systematic evaluation showed no differences in HBsAg disappearance and seroconversion rates between PEG-IFNα + placebo and PEG-IFNα + LAM for 48-52 weeks in subjects with HBeAg-positive CHB.A systematic assessment found no differences in HBsAg disappearance and seroconversion rates between PEG-IFNα + placebo and PEG-IFNα + LAM during 24 weeks' to 3 years' followup after treatment in subjects with HBeAg-negative CHB.Conclusion: Combined therapy with PEG-IFNα and LAM or ADV was not superior to monotherapy with PEG-IFNα in terms of HBsAg seroclearance or seroconversion

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

“…However, at present, it is unknown which strategy is more effective. Published meta‐analyses were mainly conducted to compare efficacy between combination therapy and monotherapy. Therefore, this meta‐analysis was performed to establish the overall proportion of HBsAg loss in different combination strategies.…”

“…However, at present, it is unknown which strategy is more effective. Published meta-analyses [15][16][17] were mainly conducted to compare efficacy between combination therapy and monotherapy.…”

The efficacy of hepatitis B treatments in achieving HBsAg seroclearance: A systematic review and meta‐analysis

“…Moreover, they did not compare combination therapy to pegylated IFN monotherapy. In another meta‐analysis, Zhang et al 6 examined combination therapy with IFN and either LAM or adefovir compared with IFN alone, and found no differences in HBsAg clearance. Consequently, there is some discrepancy between whether combination therapy is really more efficacious than IFN monotherapy.…”

“…With the increasing interest in new agents to treat CHB, it is timely to examine systematically the efficacy of existing therapy. Published meta‐analysis of HBsAg seroclearance with existing therapy either compared efficacy between combination therapy (immunomodulator and nucleoside analogues) and nucleoside analogue monotherapy 5‐7 or using different combinations (immunomodulator and nucleoside analogues)of therapy 8 . However, no meta‐analysis has examined all three treatment strategies.…”

Depression and anxiety disorders during pegylated interferon treatment in patients with chronic hepatitis B

“…Pegylation of IFN-α improves its pharmacokinetics and prolongs its half-life; so pegylated interferon (Peg-IFN) had replaced the conventional IFN because of a better pharmacokinetic profile, more convenient once weekly dosing, and superior efficacy [3]. Despite new treatment strategies for CHB, IFN treatment is in use either by monotherapy or by combination [5][6][7].…”