Li Min, Li Qinghong, Qu Jianhui, Yang Huiyin, Lv Tingting, Kong Yuanyuan, Zhang Hongfei
Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Beijing Clinical Research Institute, Beijing, China.
Hepatol Int. 2023 Feb;17(1):52-62. doi: 10.1007/s12072-022-10415-7. Epub 2022 Dec 5.
It is a challenging issue regarding the optimal antiviral treatment of children with chronic hepatitis B (CHB). The efficacy comparison of interferon (IFN) or nucleos(t)ide analogs (NAs) monotherapy with their combination could better understand this issue.
PubMed, EMBASE, Cochrane Library, Wanfang, CNKI, and abstracts of major international hepatology meetings were searched from inception to Feb 8, 2022. Randomized control trials and observational studies reporting the efficacy of combination therapy with IFN and NAs in children with CHB were eligible.
A total of 17 studies were included. Compared with IFN monotherapy, combination therapy with IFN and NAs was significantly associated with increased rates of HBV DNA undetectable, HBeAg clearance, HBeAg seroconversion, alanine transaminase (ALT) normalization as well as the composite treatment response both at the end of treatment and during the follow-up period (RRs ranged from 1.23 to 1.75). A favorable trend for HBsAg seroconversion was found in IFN plus NAs-treated children, but not for the HBsAg clearance at the end of treatment. Although a similar trend towards the superiority of the combination therapy versus NAs monotherapy was observed (RRs ranged from 1.24 to 2.33) except for the HBV DNA undetectable rate at the end of treatment, the number of reported studies was limited.
Combination therapy with IFN and NAs is more effective than IFN monotherapy in viral suppression and serological response for children with CHB. More studies were still needed to reveal the efficacy of this combination therapy compared with NAs monotherapy.
慢性乙型肝炎（CHB）患儿的最佳抗病毒治疗是一个具有挑战性的问题。干扰素（IFN）或核苷（酸）类似物（NAs）单药治疗与其联合治疗的疗效比较有助于更好地理解这一问题。
检索了PubMed、EMBASE、Cochrane图书馆、万方、知网以及主要国际肝病学会议的摘要，检索时间从数据库建库至2022年2月8日。纳入报告IFN与NAs联合治疗CHB患儿疗效的随机对照试验和观察性研究。
共纳入17项研究。与IFN单药治疗相比，IFN与NAs联合治疗在治疗结束时和随访期间，与不可检测到HBV DNA、HBeAg清除、HBeAg血清学转换、丙氨酸转氨酶（ALT）正常化以及综合治疗反应率增加显著相关（相对危险度范围为1.23至1.75）。在接受IFN加NAs治疗的儿童中发现了HBsAg血清学转换的有利趋势，但在治疗结束时未发现HBsAg清除的有利趋势。尽管观察到联合治疗相对于NAs单药治疗有类似的优势趋势（相对危险度范围为1.24至2.33），但除了治疗结束时不可检测到HBV DNA的比率外，报告的研究数量有限。
IFN与NAs联合治疗在CHB患儿的病毒抑制和血清学反应方面比IFN单药治疗更有效。与NAs单药治疗相比，仍需要更多研究来揭示这种联合治疗的疗效。
