基于干扰素和核苷（酸）类似物联合治疗对慢性乙型肝炎功能性治愈的影响：系统评价和荟萃分析。
Effect of combination treatment based on interferon and nucleos(t)ide analogues on functional cure of chronic hepatitis B: a systematic review and meta-analysis.
机构信息
Institute of Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, Shenzhen, 518112, Guangdong, China.
Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
出版信息
Hepatol Int. 2020 Dec;14(6):958-972. doi: 10.1007/s12072-020-10099-x. Epub 2020 Nov 13.
BACKGROUND
Priority of antiviral treatment for patients with chronic hepatitis B (CHB) is to increase the probability of functional cure. We aimed to synthesize evidence regarding the efficacy of different combination strategies of antiviral treatment based on interferon (IFN) and nucleos(t)ide analogues (NAs) in adults with CHB.
METHODS
PubMed, Web of Science and Embase databases were searched from inception to May 26, 2019. Three types of combination strategies were studied: initial combination (IFN or NAs monotherapy as control), add-on (I: IFN add-on NAs vs. NAs; II: NAs add-on IFN vs. IFN), switch-to (I: IFN switch-to NAs vs. IFN; II: NAs switch-to IFN vs. NAs).
RESULTS
Compared to NAs monotherapy, initial combination strategy improved the probability of HBeAg loss (RR: 1.62, 95% CI 1.33-1.97) and HBsAg loss (RR: 15.59, 95% CI 3.22-75.49), while compared to IFN monotherapy, no higher rates in the loss of HBsAg or HBeAg for initial combination. Compared to NAs monotherapy, IFN add-on NAs strategy had a higher rate of HBsAg loss (RR: 4.52, 95% CI 1.95-10.47), while compared to IFN monotherapy, NAs add-on IFN had a similar outcome. Compared to NAs monotherapy, NAs switch-to IFN strategy improved HBsAg loss (RR: 12.15, 95% CI 3.99-37.01); while compared to IFN monotherapy, IFN switch-to NAs had no improved rate of HBsAg clearance but higher rates in undetectable HBV DNA, and HBeAg loss.
CONCLUSION
IFN add-on NAs, or NAs switched to IFN could significantly improve the probability of HBsAg loss compared to NAs monotherapy.
背景
慢性乙型肝炎（CHB）患者抗病毒治疗的重点是提高功能性治愈的概率。我们旨在综合基于干扰素（IFN）和核苷（酸）类似物（NAs）的不同联合治疗策略在 CHB 成人中的疗效证据。
方法
从建库到 2019 年 5 月 26 日，我们检索了 PubMed、Web of Science 和 Embase 数据库。研究了三种联合策略：初始联合（IFN 或 NAs 单药治疗作为对照）、添加（I：IFN 添加 NAs 与 NAs 相比；II：NAs 添加 IFN 与 IFN 相比）、转换（I：IFN 转换为 NAs 与 IFN 相比；II：NAs 转换为 IFN 与 NAs 相比）。
结果
与 NAs 单药治疗相比，初始联合策略提高了 HBeAg 丢失（RR：1.62，95%CI 1.33-1.97）和 HBsAg 丢失（RR：15.59，95%CI 3.22-75.49）的概率，而与 IFN 单药治疗相比，初始联合策略在 HBsAg 或 HBeAg 丢失方面没有更高的比率。与 NAs 单药治疗相比，IFN 添加 NAs 策略的 HBsAg 丢失率更高（RR：4.52，95%CI 1.95-10.47），而与 IFN 单药治疗相比，NAs 添加 IFN 则具有相似的结果。与 NAs 单药治疗相比，NAs 转换为 IFN 策略可提高 HBsAg 丢失率（RR：12.15，95%CI 3.99-37.01）；而与 IFN 单药治疗相比，IFN 转换为 NAs 并没有提高 HBsAg 清除率，但可提高 HBV DNA 不可检测率和 HBeAg 丢失率。
结论
与 NAs 单药治疗相比，IFN 添加 NAs 或 NAs 转换为 IFN 可显著提高 HBsAg 丢失的概率。
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