Lee Soon Kyu, Kwon Jung Hyun, Lee Sung Won, Jang Jeong Won, Nam Heechul, Baik Kyoung Won, Yoo Sun Hong, Nam Soon Woo, Sung Pil Soo, Bae Si Hyun, Choi Jong Young, Yoon Seung Kew
Division of Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.
Liver Int. 2021 Feb;41(2):288-294. doi: 10.1111/liv.14701. Epub 2020 Nov 17.
BACKGROUND & AIMS: Nucleos(t)ide analogue (NA) therapy in chronic hepatitis B (CHB) patients reduces liver-related mortality. However, long-term outcomes after pegylated interferon (PEG-IFN) therapy remain to be elucidated. Therefore, we aimed to investigate the long-term effectiveness and clinical outcomes of PEG-IFN therapy.
A total of 190 patients treated with PEG-IFN for CHB or compensated cirrhosis were consecutively enrolled between 2005 and 2014, and 122 patients who completed the treatment were analysed. The initial response was assessed at 6 months post-treatment and defined as achieving both <2000 IU/mL HBV DNA and HBeAg loss or seroconversion in the HBeAg-positive group, and <2000 IU/mL HBV DNA in the HBeAg-negative group. The rates of HBsAg loss, disease progression to cirrhosis or HCC, and sustained off-therapy response, defined as not requiring further NAs because of low viremia and liver enzymes, were analysed.
The median follow-up period was 7.2 years. Forty-three (35.2%) patients achieved an initial response and 53 patients (43.4%) achieved a sustained response. Initial responders displayed higher rates of sustained response than noninitial responders (69.6% vs 32.5%, P < .001). A higher rate of HBsAg loss was observed in patients who achieved a sustained response than in non-sustained responders (16.2% vs 2.5%, P = .01). Disease progression to cirrhosis or HCC was observed in eight patients (6.6%) who were nonsustained responders.
During long-term follow-up after PEG-IFN treatment, nearly half of patients achieved sustained response without the need of further NA and these patients displayed favourable outcomes, including HBsAg loss and no disease progression.
核苷（酸）类似物（NA）疗法可降低慢性乙型肝炎（CHB）患者的肝脏相关死亡率。然而，聚乙二醇干扰素（PEG-IFN）治疗后的长期结局仍有待阐明。因此，我们旨在研究PEG-IFN治疗的长期疗效和临床结局。
2005年至2014年期间，连续纳入190例接受PEG-IFN治疗的CHB或代偿期肝硬化患者，对其中122例完成治疗的患者进行分析。治疗后6个月评估初始反应，定义为HBeAg阳性组HBV DNA<2000 IU/mL且HBeAg消失或血清学转换，HBeAg阴性组HBV DNA<2000 IU/mL。分析HBsAg消失率、疾病进展为肝硬化或肝癌的发生率以及持续停药反应率，持续停药反应定义为因病毒血症低和肝酶正常而无需进一步使用NA。
中位随访期为7.2年。43例（35.2%）患者达到初始反应，53例（43.4%）患者达到持续反应。初始反应者的持续反应率高于非初始反应者（69.6%对32.5%，P<0.001）。达到持续反应的患者HBsAg消失率高于未达到持续反应的患者（16.2%对2.5%，P=0.01）。8例（6.6%）未达到持续反应的患者出现疾病进展为肝硬化或肝癌。
在PEG-IFN治疗后的长期随访中，近一半的患者达到持续反应，无需进一步使用NA，这些患者显示出良好的结局，包括HBsAg消失和无疾病进展。
