Peginterferon is preferable to entecavir for prevention of unfavourable events in patients with HBeAg‐positive chronic hepatitis B: A five‐year observational cohort study

Abstract

At present, the long-term effects of pegylated interferon-α (PEG-IFN-α) and entecavir (ETV) are controversial. Studies directly compared the long-term outcomes of these two drugs have not been completed. This study was designed to compare the clinical outcomes of PEG-IFN-α vs ETV therapy in Chinese patients with chronic HBV infection. From September 2008 to December 2016, a large, observational, open-label, prospective cohort study of HBeAg-positive patients with CHB who received PEG-IFN-α or ETV therapy was carried out at the Second Affiliated Hospital of Chongqing Medical University. Cumulative incidences of unfavourable events were calculated with respect to treatment type. Based on the REACH-B model, we compared the observed incidence of hepatocellular carcinoma (HCC) with the expected incidence in each group. PEG-IFN-α-treated patients showed a lower cumulative incidences of unfavourable events and cirrhosis than those treated with ETV (P = .031; P = .044, respectively). Impact factor exploration indicated that treatment type and platelet count are significantly associated with the occurrence of unfavourable events. Based on the REACH-B model, a lower observed cumulative incidence of HCC was observed in PEG-IFN-α-treated patients than predicted (P = .038). However, there was no significant difference of the cumulative HCC incidence between the observed and the predicted cases for ETV-experienced patients (P = .36). Treatment with PEG-INF-α leads to a lower incidence of unfavourable events including cirrhosis and HCC than ETV in patients with HBV. Treatment type and baseline platelet count may be two important factors associated with the long-term clinical outcomes of patients with CHB.

Effects of pegylated interferon‐α based therapies on functional cure and the risk of hepatocellular carcinoma development in patients with chronic hepatitis B

“…Some recent studies have shown a trend towards a lower incidence of HCC in patients receiving IFN‐based therapy compared with NA therapy, especially in patients with a high risk of HCC at baseline (Table ). A prospective cohort study conducted in the Second Affiliated Hospital, Chongqing Medical University, demonstrated that compared with HBeAg‐positive CHB patients treated with ETV for at least 1 year, those treated with peg‐IFN‐α for at least 6 months had lower 5‐year cumulative incidences of unfavourable events (which included cirrhosis and HCC) and cirrhosis (unfavourable events: 9.1% vs 0%, respectively; P = 0.031; cirrhosis: 7.9% vs 0%, respectively; P = 0.044). HCC incidences were lower in both groups, with no statistically significant difference between them (ETV group: 3.8%, peg‐IFN‐α group: 0%, P = 0.209).…”

“…A prospective cohort study 78 Another retrospective study conducted at Chang Gung Memorial Hospital, Taiwan, 80 showed that among baseline-matched patients, those receiving peg-IFNα monotherapy or sequential therapy had lower HCC incidences than those receiving long-term NA monotherapy (P = 0.009). The multivariate analysis indicated that treatment type was independently associated with HCC occurrence (HR: 0.103 for peg-IFNα-containing therapy vs NAs monotherapy; P = 0.031)…”

Predictors of sustained functional cure in hepatitis B envelope antigen‐negative patients achieving hepatitis B surface antigen seroclearance with interferon‐alpha–based therapy

“…Treatment guidelines of chronic hepatitis B (CHB) recommended antiviral therapy to delay the progression of liver disease and to reduce the incidence of cirrhosis and hepatic carcinoma . However, the incidence of hepatic carcinoma is significantly different among antiviral treatments . Interferon (IFN) therapy achieved higher rates of sustained viral response and hepatitis B surface antigen (HBsAg) loss than nucleos(t)ide analogue (NA) after discontinuing treatment .…”

“…[1][2][3] However, the incidence of hepatic carcinoma is significantly different among antiviral treatments. 4,5 Interferon (IFN) therapy achieved higher rates of sustained viral response and hepatitis B surface antigen (HBsAg) loss than nucleos(t)ide analogue (NA) after discontinuing treatment. 6,7 In Asian CHB patients, IFN therapy has been reported to significantly reduce the occurrence of HCC, resulting in lower ratio of HCC than NA treatment.…”

HBsAg quantification predicts off-treatment response to interferon in chronic hepatitis B patients：A retrospective study of 250 cases

“…It has been demonstrated by recent large randomised NEPTUNE study that the immune response of IFN therapy is durable for up to 5 years(10). Since long-term benefits of CHB patients are held in highly regard, a five-year observational cohort study demonstrated that treatment with IFN leads to a significant lower incidence of unfavorable events than entecavir in CHB patients (11). A phase 3 clinical trial has also reported that in hepatitis B e antigen (HBeAg)-positive CHB patients treated with IFN, 14% initial nonresponders achieved delayed response 6-12 months post-treatment, and 86% initial responders maintained sustained response for up to 1 year (12).…”