The Key Laboratory of Molcular Biology for Infectious Diseases, Department of Infectious Diseases, Institute for Viral Hepatitis, Chinese Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Aliment Pharmacol Ther. 2018 May;47(10):1340-1348. doi: 10.1111/apt.14629. Epub 2018 Mar 26.
The seroclearance of hepatitis B surface antigen (HBsAg) in patients with chronic hepatitis B (CHB) is considered to be associated with favourable clinical outcomes.
This meta-analysis was performed to establish the proportion of HBsAg loss rates among CHB patients who received combination treatment based on pegylated interferon (PegIFN). Four combination strategies have been studied with the aim of improving HBsAg loss: "de novo," "NA-experienced," "switch-to" and "add-on." This meta-analysis was performed to determine which, if any, of these combination strategies was more effective.
Medline, Web of Science and Embase databases were searched from inception to December 2017. The proportion of patients who achieved HBsAg loss after combination therapy was pooled using a random-effects model.
Twenty-four studies fulfilled the meta-analysis criteria. The overall pooled proportion suggested that the rate of HBsAg loss could be increased to 9% (95% CI: 7%-12%) based on the combination treatment in CHB patients. Compared with "de novo" strategy (8%, 95% CI: 6%-10%), the "nucleos(t)ide analogues-experienced" (11%, 95% CI: 8%-15%) was found to be more likely (P = 0.036) to achieve a response. Compared with the "add-on" strategy (8%, 95% CI: 5%-13%), the "switch-to" (14%, 95% CI: 9%-20%) was found to be more likely (P = 0.012) to achieve HBsAg loss.
The "nucleos(t)ide analogues-experienced" strategy was more effective than the "De novo" strategy in achieving HBsAg loss for CHB patients. Combination treatment using regimens based on Peg-IFN may be useful to help nucleos(t)ide analogues-treated patients, who have experienced at least 48 weeks of nucleot(s)ide analogue, achieve HBsAg seroclearance.
乙型肝炎表面抗原（HBsAg）在慢性乙型肝炎（CHB）患者中的血清清除被认为与良好的临床结局相关。
本荟萃分析旨在确定接受聚乙二醇干扰素（PegIFN）联合治疗的 CHB 患者中 HBsAg 丢失率的比例。已经研究了四种联合策略，旨在提高 HBsAg 丢失率：“初治”、“核苷（酸）类似物经治”、“转换治疗”和“添加治疗”。本荟萃分析旨在确定这些联合策略中哪一种（如果有的话）更有效。
从创建到 2017 年 12 月，检索 Medline、Web of Science 和 Embase 数据库。使用随机效应模型汇总联合治疗后实现 HBsAg 丢失的患者比例。
24 项研究符合荟萃分析标准。总体汇总比例表明，基于 CHB 患者的联合治疗，HBsAg 丢失率可提高至 9%（95%CI：7%-12%）。与“初治”策略（8%，95%CI：6%-10%）相比，“核苷（酸）类似物经治”（11%，95%CI：8%-15%）更有可能（P=0.036）获得应答。与“添加治疗”策略（8%，95%CI：5%-13%）相比，“转换治疗”（14%，95%CI：9%-20%）更有可能（P=0.012）实现 HBsAg 丢失。
“核苷（酸）类似物经治”策略在实现 CHB 患者 HBsAg 丢失方面比“初治”策略更有效。基于 Peg-IFN 的治疗方案联合治疗可能有助于帮助已接受至少 48 周核苷（酸）类似物治疗的患者实现 HBsAg 血清学清除。
