Why do I treat HBeAg-negative chronic hepatitis B patients with pegylated interferon?

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Chronic hepatitis B (CHB) in serum HBeAg negative patients is a difficult to cure, progressive disease leading to end-stage liver disease and hepatocellular carcinoma. Currently, there are two different treatment strategies for such patients: a finite course of Pegylated interferon (PEG-IFN) or long-term administration of the more potent and less resistance-prone nucleot(s)ide analogues (NUC), i.e. entecavir and tenofovir. Although NUC may ensure persistent viral suppression by preventing disease progression in most patients, they require lifelong administration with the hypothetical disadvantages of cost, lack of long-term safety data and, most important, the null rates of HBsAg seroclearance. On the other hand, 1 year of PEG-IFN has the advantage of providing an immune-mediated control of hepatitis B virus (HBV) infection, with the possibility of achieving a sustained off-treatment response in 20% of the patients, ultimately leading to HBsAg loss in approximately 50% of these. However, these sustained response rates can be significantly increased by carefully selecting candidates for PEG-IFN therapy based upon baseline ALT and HBV DNA levels, viral genotype and IL28B polymorphisms, by extending PEG-IFN therapy beyond 48 weeks and, most importantly, by applying early on-treatment stopping rules based upon HBsAg kinetics. Overall, PEG-IFN is an ideal treatment strategy in selected patients with HBeAg-negative CHB, because of its well-recognized and predictable safety profile and a unique mechanism of antiviral activity leading to long-lasting immune control. Because of these features, new therapeutic trials based upon a combination of PEG-IFN and third generation NUC such as entecavir and tenofovir, in both naïve and NUC-exposed patients, are ongoing to further increase the rates of HBsAg seroclearance, which remains the 'ideal end-point' in all HBeAg-negative CHB subjects.

Original languageEnglish
Pages (from-to)157-163
Number of pages7
JournalLiver International
Volume33
Issue numberSUPPL. 1
DOIs
Publication statusPublished - Feb 2013

Fingerprint

Hepatitis B e Antigens
Chronic Hepatitis B
Interferons
Tenofovir
Hepatitis B Surface Antigens
Hepatitis B virus
Therapeutics
Safety
End Stage Liver Disease
Viral DNA
Virus Diseases
Antiviral Agents
Disease Progression
Hepatocellular Carcinoma
Genotype
Costs and Cost Analysis
Serum

Keywords

  • Chronic hepatitis B
  • HBeAg-negative
  • HBsAg levels
  • HBV DNA
  • IL28B polymorphism
  • PEG-IFNα
  • Sustained response

ASJC Scopus subject areas

  • Hepatology

Cite this

Why do I treat HBeAg-negative chronic hepatitis B patients with pegylated interferon? / Lampertico, Pietro; Viganò, Mauro; Colombo, Massimo.

In: Liver International, Vol. 33, No. SUPPL. 1, 02.2013, p. 157-163.

Research output: Contribution to journalArticle

@article{e75c03ae5642461ea8a7f13c25567193,
title = "Why do I treat HBeAg-negative chronic hepatitis B patients with pegylated interferon?",
abstract = "Chronic hepatitis B (CHB) in serum HBeAg negative patients is a difficult to cure, progressive disease leading to end-stage liver disease and hepatocellular carcinoma. Currently, there are two different treatment strategies for such patients: a finite course of Pegylated interferon (PEG-IFN) or long-term administration of the more potent and less resistance-prone nucleot(s)ide analogues (NUC), i.e. entecavir and tenofovir. Although NUC may ensure persistent viral suppression by preventing disease progression in most patients, they require lifelong administration with the hypothetical disadvantages of cost, lack of long-term safety data and, most important, the null rates of HBsAg seroclearance. On the other hand, 1 year of PEG-IFN has the advantage of providing an immune-mediated control of hepatitis B virus (HBV) infection, with the possibility of achieving a sustained off-treatment response in 20{\%} of the patients, ultimately leading to HBsAg loss in approximately 50{\%} of these. However, these sustained response rates can be significantly increased by carefully selecting candidates for PEG-IFN therapy based upon baseline ALT and HBV DNA levels, viral genotype and IL28B polymorphisms, by extending PEG-IFN therapy beyond 48 weeks and, most importantly, by applying early on-treatment stopping rules based upon HBsAg kinetics. Overall, PEG-IFN is an ideal treatment strategy in selected patients with HBeAg-negative CHB, because of its well-recognized and predictable safety profile and a unique mechanism of antiviral activity leading to long-lasting immune control. Because of these features, new therapeutic trials based upon a combination of PEG-IFN and third generation NUC such as entecavir and tenofovir, in both na{\"i}ve and NUC-exposed patients, are ongoing to further increase the rates of HBsAg seroclearance, which remains the 'ideal end-point' in all HBeAg-negative CHB subjects.",
keywords = "Chronic hepatitis B, HBeAg-negative, HBsAg levels, HBV DNA, IL28B polymorphism, PEG-IFNα, Sustained response",
author = "Pietro Lampertico and Mauro Vigan{\`o} and Massimo Colombo",
year = "2013",
month = "2",
doi = "10.1111/liv.12064",
language = "English",
volume = "33",
pages = "157--163",
journal = "Liver International",
issn = "1478-3223",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "SUPPL. 1",

}

TY - JOUR

T1 - Why do I treat HBeAg-negative chronic hepatitis B patients with pegylated interferon?

AU - Lampertico, Pietro

AU - Viganò, Mauro

AU - Colombo, Massimo

PY - 2013/2

Y1 - 2013/2

N2 - Chronic hepatitis B (CHB) in serum HBeAg negative patients is a difficult to cure, progressive disease leading to end-stage liver disease and hepatocellular carcinoma. Currently, there are two different treatment strategies for such patients: a finite course of Pegylated interferon (PEG-IFN) or long-term administration of the more potent and less resistance-prone nucleot(s)ide analogues (NUC), i.e. entecavir and tenofovir. Although NUC may ensure persistent viral suppression by preventing disease progression in most patients, they require lifelong administration with the hypothetical disadvantages of cost, lack of long-term safety data and, most important, the null rates of HBsAg seroclearance. On the other hand, 1 year of PEG-IFN has the advantage of providing an immune-mediated control of hepatitis B virus (HBV) infection, with the possibility of achieving a sustained off-treatment response in 20% of the patients, ultimately leading to HBsAg loss in approximately 50% of these. However, these sustained response rates can be significantly increased by carefully selecting candidates for PEG-IFN therapy based upon baseline ALT and HBV DNA levels, viral genotype and IL28B polymorphisms, by extending PEG-IFN therapy beyond 48 weeks and, most importantly, by applying early on-treatment stopping rules based upon HBsAg kinetics. Overall, PEG-IFN is an ideal treatment strategy in selected patients with HBeAg-negative CHB, because of its well-recognized and predictable safety profile and a unique mechanism of antiviral activity leading to long-lasting immune control. Because of these features, new therapeutic trials based upon a combination of PEG-IFN and third generation NUC such as entecavir and tenofovir, in both naïve and NUC-exposed patients, are ongoing to further increase the rates of HBsAg seroclearance, which remains the 'ideal end-point' in all HBeAg-negative CHB subjects.

AB - Chronic hepatitis B (CHB) in serum HBeAg negative patients is a difficult to cure, progressive disease leading to end-stage liver disease and hepatocellular carcinoma. Currently, there are two different treatment strategies for such patients: a finite course of Pegylated interferon (PEG-IFN) or long-term administration of the more potent and less resistance-prone nucleot(s)ide analogues (NUC), i.e. entecavir and tenofovir. Although NUC may ensure persistent viral suppression by preventing disease progression in most patients, they require lifelong administration with the hypothetical disadvantages of cost, lack of long-term safety data and, most important, the null rates of HBsAg seroclearance. On the other hand, 1 year of PEG-IFN has the advantage of providing an immune-mediated control of hepatitis B virus (HBV) infection, with the possibility of achieving a sustained off-treatment response in 20% of the patients, ultimately leading to HBsAg loss in approximately 50% of these. However, these sustained response rates can be significantly increased by carefully selecting candidates for PEG-IFN therapy based upon baseline ALT and HBV DNA levels, viral genotype and IL28B polymorphisms, by extending PEG-IFN therapy beyond 48 weeks and, most importantly, by applying early on-treatment stopping rules based upon HBsAg kinetics. Overall, PEG-IFN is an ideal treatment strategy in selected patients with HBeAg-negative CHB, because of its well-recognized and predictable safety profile and a unique mechanism of antiviral activity leading to long-lasting immune control. Because of these features, new therapeutic trials based upon a combination of PEG-IFN and third generation NUC such as entecavir and tenofovir, in both naïve and NUC-exposed patients, are ongoing to further increase the rates of HBsAg seroclearance, which remains the 'ideal end-point' in all HBeAg-negative CHB subjects.

KW - Chronic hepatitis B

KW - HBeAg-negative

KW - HBsAg levels

KW - HBV DNA

KW - IL28B polymorphism

KW - PEG-IFNα

KW - Sustained response

UR - http://www.scopus.com/inward/record.url?scp=84872039847&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872039847&partnerID=8YFLogxK

U2 - 10.1111/liv.12064

DO - 10.1111/liv.12064

M3 - Article

VL - 33

SP - 157

EP - 163

JO - Liver International

JF - Liver International

SN - 1478-3223

IS - SUPPL. 1

ER -