Hepatitis B e antigen as a predictor for hepatitis B e antigen–positive chronic hepatitis B patients with peginterferon alfa-2a therapy #

Abstract

PROVE1 trial, 1 in which in the group with an identical treatment schedule, the percentage of patients obtaining SVR with respect to RVR was 75% only. In other words, RVR seems easier to obtain with telaprevir, but less frequently predicts a favorable treatment outcome. A possible explanation might reside in the suboptimal exposure in the majority of telaprevir groups to peginterferon and ribavirin (12 or 24 weeks, instead of the standard 48 weeks); however, it should also be considered that common on-treatment virological predictors might have a different meaning when they are obtained through different pharmacological approaches. As the background of a picture may vary according to the position of either the subject or the photographer, so too when we frame RVR deriving from a different path, we might expect a different perspective. Our observation is not aimed at denoting a possible negative aspect in the use of a promising new drug; instead, we want to underscore the importance of constantly and critically revising the meaning of our on-treatment virological indicators when a new drug is employed. Hopefully, we will all become good photographers. LEONARDO Hepatitis B e Antigen as a Predictor for Hepatitis B e Antigen-Positive Chronic Hepatitis B Patients with Peginterferon Alfa-2a TherapyTo the Editor:To evaluate the usefulness of quantitative hepatitis B e antigen (HBeAg) values for predicting HBeAg seroconversion in patients treated with peginterferon alfa-2a, Fried et al. 1 analyzed 271 patients infected with hepatitis B virus (HBV) who were HBeAgpositive and who received peginterferon alfa-2a plus oral placebo for 48 weeks, and found that quantitative HBeAg is a useful adjunct measurement for predicting HBeAg seroconversion in patients treated with peginterferon when considering both sensitivity and specificity compared with serum HBV DNA. As we know, HBeAg and HBV DNA are not independent variables, so when we used the level of HBeAg at week 12 or 24 to predict the rate of HBeAg seroconversion at week 72, the level of HBV DNA for those patients should be analyzed. For example, were the levels of HBV DNA similar between patients with different levels of HBeAg (Ͻ10 Paul Ehrlich Institute unit [PEIU]/mL, 10-100 PEIU/mL, and Ͼ100 PEIU/mL)? If not, the conclusions obtained from this study should be verified further. In addition, the author described that HBV DNA was measured using in vitro nucleic acid amplification using the Cobas Amplicor HBV Monitor, with a working range of 400 (lower limit of detection) to 40,000,000 copies/mL, but in Fig. 3B of the result, it was showed the level of HBV DNA was divided into three grades (Ͻ5log10, 5-9 log10, and Ͼ9 log10). We hope the authors could clarify this issue.