He Li-Ting, Ye Xiao-Guang, Zhou Xiao-Yuan
Li-Ting He, Xiao-Guang Ye, Xiao-Yuan Zhou, Department of Infectious Diseases, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong Province, China.
World J Gastroenterol. 2016 Dec 14;22(46):10210-10218. doi: 10.3748/wjg.v22.i46.10210.
To investigate the efficacy of switching to pegylated interferon-α-2a (PegIFNα-2a) treatment in nucleos(t)ide analog (NA)-treated chronic hepatitis B (CHB) responder patients.
A 48-wk prospective and retrospective treatment trial of NA-treated CHB patients who had received entecavir (ETV) for at least 48 wk and had serum hepatitis B virus (HBV)-DNA < 500 IU/mL, serum hepatitis B envelope antigen (HBeAg) < 100 S/CO, serum alanine aminotransferase, and aspartate aminotransferase levels < 2 × the upper limit of normal of 40 IU/L was performed. The effects on virological and serological responses and adverse reactions to 0.5 mg daily ETV for 48 wk switching to PegIFNα-2a were compared. Forty-four patients were randomized to be switched from NA treatment to the PegIFNα-2a group, and 44 patients were simultaneously randomized to the ETV group.
After 48 wk of therapy, the decrease in hepatitis B surface antigen (HBsAg) levels was greater in the PegIFNα-2a group than in the ETV group (3.1340 log IU/mL 3.6950 log IU/mL, = 0.00). Seven patients who were anti-HBs-positive at baseline achieved HBsAg loss when switched to PegIFNα-2a (15.91% 0%, = 0.018). The HBeAg serological conversion rate was higher in the PegIFNα-2a group than in the ETV group; however, the difference was not significant because of the small sample sizes (34.38% 21.88%, = 0.232). In the PegIFNα-2a group, patients with HBsAg levels < 1500 IU/mL at baseline had higher HBeAg seroconversion and HBsAg loss rates at week 48 than those with HBsAg levels ≥ 1500 IU/mL (HBeAg seroconversion: 17.86% 62.5%, = 0.007; HBsAg loss: 41.67% 6.25%, = 0.016). Moreover, patients with HBsAg levels < 1500 IU/mL at week 24 had higher HBsAg loss rates after therapy than those with HBsAg levels ≥ 1500 IU/mL (36.84% 0%, = 0.004). However, there were no statistically significant differences in HBeAg seroconversion rates (47.06% 25.93%, = 0.266).
NA-treated CHB patients switched to sequential PegIFNα-2a achieved highly potent treatment termination safely.
探讨核苷（酸）类似物（NA）治疗的慢性乙型肝炎（CHB）应答患者换用聚乙二醇化干扰素-α-2a（PegIFNα-2a）治疗的疗效。
对接受恩替卡韦（ETV）治疗至少48周且血清乙型肝炎病毒（HBV）-DNA<500 IU/mL、血清乙型肝炎e抗原（HBeAg）<100 S/CO、血清丙氨酸氨基转移酶和天冬氨酸氨基转移酶水平<40 IU/L正常上限2倍的NA治疗的CHB患者进行了一项为期48周的前瞻性和回顾性治疗试验。比较了每日0.5 mg ETV治疗48周后换用PegIFNα-2a对病毒学和血清学应答及不良反应的影响。44例患者被随机分为从NA治疗换至PegIFNα-2a组，44例患者同时被随机分为ETV组。
治疗48周后，PegIFNα-2a组乙型肝炎表面抗原（HBsAg）水平下降幅度大于ETV组（3.1340 log IU/mL对3.6950 log IU/mL，P = 0.00）。7例基线时抗-HBs阳性的患者换用PegIFNα-2a后实现了HBsAg消失（15.91%对0%，P = 0.018）。PegIFNα-
