Switching from entecavir to PegIFN alfa-2a in patients with HBeAg-positive chronic hepatitis B: A randomised open-label trial (OSST trial)

Ning, Qin; Han, Meifang; Sun, Yongtao; Jiang, Jiaji; Tan, Deming; Hou, Jinlin; Tang, Hong; Sheng, Jifang; Zhao, Mianzhi

doi:10.1016/j.jhep.2014.05.044

Cited by 215 publications

(256 citation statements)

References 37 publications

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“…Baseline HBsAg \1,500 IU/ml predicted the serological responses. 135,136 Two additional Asian studies assessed whether a 48-week course of add-on PegIFNa was superior to long-term NA therapy in HBeAg-positive patients. 137,138 While the HBsAg decline was superior in the combination group, the HBsAg loss rates did not increase significantly.…”

Section: Na Plus Pegifna Recommendationsmentioning

confidence: 99%

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

Lampertico¹,

Agarwal²,

Berg³

et al. 2017

Journal of Hepatology

4,184

3,081

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Section: Na Plus Pegifna Recommendationsmentioning

confidence: 99%

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

Lampertico¹,

Agarwal²,

Berg³

et al. 2017

Journal of Hepatology

4,184

3,081

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“…Evidence that such an approach may be somewhat more effective than monotherapies is emerging from clinical trials in which IFN therapy is added on to patients receiving NUC therapy, or when patients on NUC therapy are switched to IFN after an 8 weeks overlap period (Kittner et al, 2012;Ning et al, 2014;Ouzan et al, 2013). Patients who responded to these combinations showed higher rates of HBeAg and HBsAg seroclearance than those continuing on NUC therapy alone.…”

Section: Clinical Experience Using Arc-520mentioning

confidence: 99%

Synthetic RNAi triggers and their use in chronic hepatitis B therapies with curative intent

et al. 2015

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Current therapies for chronic hepatitis B virus infection (CHB) - nucleos(t)ide analogue reverse transcriptase inhibitors and interferons - result in low rates of functional cure defined as sustained off-therapy seroclearance of hepatitis B surface antigen (HBsAg). One likely reason is the inability of these therapies to consistently and substantially reduce the levels of viral antigen production. Accumulated evidence suggests that high serum levels of HBsAg result in exhaustion of the host immune system, rendering it unable to mount the effective antiviral response required for HBsAg clearance. New mechanistic approaches are required to produce high rates of HBsAg seroclearance in order to greatly reduce off-treatment disease progression. Already shown to be a clinically viable means of reducing gene expression in a number of other diseases, therapies based on RNA interference (RNAi) can directly target hepatitis B virus transcripts with high specificity, profoundly reducing the production of viral proteins. The fact that the viral RNA transcripts contain overlapping sequences means that a single RNAi trigger can result in the degradation of all viral transcripts, including all messenger RNAs and pregenomic RNA. Advances in the design of RNAi triggers have increased resistance to degradation and reduced nonspecific innate immune stimulation. Additionally, new methods to effectively deliver the trigger to liver hepatocytes, and specifically to the cytoplasmic compartment, have resulted in increased efficacy and tolerability. An RNAi-based drug currently in clinical trials is ARC-520, a dynamic polyconjugate in which the RNAi trigger is conjugated to cholesterol, which is coinjected with a hepatocyte-targeted, membrane-active peptide. Phase 2a clinical trial results indicate that ARC-520 was well tolerated and resulted in significant, dose-dependent reduction in HBsAg for up to 57days in CHB patients. RNAi-based therapies may play an important role in future therapeutic regimes aimed at improving HBsAg seroclearance and eliminating the need for lifelong therapy. This paper forms part of a symposium in Antiviral Research on "An unfinished story: from the discovery of the Australia antigen to the development of new curative therapies for hepatitis B."

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“…Early studies reported the efficacy of de novo or sequential combination of interferon and NUCs, which failed to show a benefit for this approach (4,5,14). A recent study reported the efficacy of switching to a finite course of Peg-IFN-␣2a in patients on long-term ETV who have not experienced HBeAg seroconversion despite sustained HBV suppression (15). The result showed that patients who switched to Peg-IFN-␣2a achieved higher HBeAg seroconversion at week 48 than those who continued ETV (14.9% versus 6.1%; P ϭ 0.0467) and only patients receiving Peg-IFN-␣2a achieved HBsAg loss (8.5%).…”

Section: Discussionmentioning

confidence: 99%

Sequential Combination Therapy with Pegylated Interferon Leads to Loss of Hepatitis B Surface Antigen and Hepatitis B e Antigen (HBeAg) Seroconversion in HBeAg-Positive Chronic Hepatitis B Patients Receiving Long-Term Entecavir Treatment

Chen

et al. 2015

Antimicrob Agents Chemother

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e Nucleos(t)ide analogues rarely result in a durable off-treatment response in chronic hepatitis B infection, whereas pegylated interferon (Peg-IFN) induces a long-lasting response only in a subset of patients. We assessed the effect of sequential combination therapy with Peg-IFN-␣2a and entecavir in hepatitis B e antigen (HBeAg)-positive patients with prior long-term entecavir therapy and investigated the predictors of response to treatment. HBeAg-positive individuals who did not achieve HBeAg seroconversion during previous long-term entecavir therapy, receiving Peg-IFN-␣2a added to ongoing entecavir therapy (sequential combination [S-C] therapy; n ‫؍‬ 81) for 48 weeks or remaining on entecavir monotherapy (n ‫؍‬ 116), were retrospectively included. A matched pair was created at a 1:1 ratio from each treatment group. The primary endpoint was HBeAg seroconversion at week 48. Subgroup analysis of response prediction was conducted for 81 patients with S-C therapy. More patients in the S-C therapy group achieved HBeAg seroconversion than those in the entecavir group (44% versus 6%; P < 0.0001). An HBeAg level of <200 signal-to-cutoff ratio (S/CO) at baseline was a strong predictor for higher HBeAg seroconversion than that achieved when HBeAg was >200 S/CO (64.2% versus 17.9%; P < 0.0001). Hepatitis B surface antigen (HBsAg) levels at baseline and the decrease in HBsAg levels predicted HBsAg loss in the S-C therapy group. The combination of baseline HBeAg of <200 S/CO and HBsAg of <1,000 IU/ml and an HBsAg decline at week 12 of >0.5 log 10 IU/ml provided the highest rate of HBeAg seroconversion (92.31%) and HBsAg loss (83.3%) at week 48. Patients receiving sequential combination therapy have a higher rate of HBeAg seroconversion and are more likely to experience HBsAg clearance than do those continuing entecavir monotherapy. Sequential combination therapy can be guided by baseline HBsAg/HBeAg levels and on-treatment HBsAg dynamics. Hepatitis B virus (HBV) infection is endemic in Asia, the Pacific islands, Africa, Southern Europe, and Latin America, and chronic hepatitis B (CHB) is a global health threat. There are approximately 350 million chronic HBV surface antigen (HBsAg) carriers worldwide (1). Patients with CHB have an increased risk of developing cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC), which results in about 1 million deaths per year (2). Antiviral treatment is effective in halting progression of CHB in many patients. Two classes of antiviral agents are available: nucleos(t)ide analogues (NUCs), such as entecavir (ETV), which inhibit the viral polymerase and interfere with viral replication, and interferon alpha (IFN-␣), including conventional and pegylated forms, which has antiviral and immunomodulatory effects (3). NUCs are effective in most patients but must be continued indefinitely in the patients that do not achieve hepatitis B e antigen (HBeAg) seroconversion. In contrast, a finite course of pegylated IFN-␣ (Peg-IFN-␣) can induce a long-lasting therapeutic response, but on...

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Switching from entecavir to PegIFN alfa-2a in patients with HBeAg-positive chronic hepatitis B: A randomised open-label trial (OSST trial)

Cited by 215 publications

References 37 publications

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

Synthetic RNAi triggers and their use in chronic hepatitis B therapies with curative intent

Sequential Combination Therapy with Pegylated Interferon Leads to Loss of Hepatitis B Surface Antigen and Hepatitis B e Antigen (HBeAg) Seroconversion in HBeAg-Positive Chronic Hepatitis B Patients Receiving Long-Term Entecavir Treatment

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