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A Better Antiviral Efficacy Found in Nucleos(t)ide Analog (NA) Combinations with Interferon Therapy than NA Monotherapy for HBeAg Positive Chronic Hepatitis B: A Meta-Analysis.

Wei W, Wu Q, Zhou J, Kong Y, You H - Int J Environ Res Public Health (2015)

Bottom Line: We used hepatitis B antigen (HBeAg) loss, HBV-DNA undetectable rate, HBeAg seroconversion, hepatitis B surface antigen (HBsAg) loss, HBsAg seroconversion, and histological score at the end of treatment for efficacy evaluation.However, there were no significant differences in HBsAg seroconversion (RR = 4.25, 95% CI = 0.62-29.13, p = 0.14), sustained virological response rates, and biochemical response rates observed between the two groups.NAs and IFN or Peg-IFN combination therapy had a better efficacy in terms of HBeAg loss, HBV-DNA undetectable rate, HBeAg seroconversion, and HBsAg loss, compared to the NA monotherapy group at the end of treatment; however, there was no significant difference in HBsAg seroconversion between the two regimens.

View Article: PubMed Central - PubMed

Affiliation: Clinical Epidemiology and Evidence-based Medicine Center, Beijing Friendship Hospital, Capital Medical University, 95 Yong-An Road, Beijing 100050, China. vivi_0306@126.com.

ABSTRACT

Background: The clinical efficacy of nucleos(t)ide analogues (NAs) combined with interferon (IFN) therapy vs. NAs monotherapy for chronic hepatitis B (CHB) remains inconclusive. The aim of this meta-analysis was to determine whether the NAs plus IFN regimen offers synergistic efficacy that justifies the cost and burden of such a combination therapy in CHB patients.

Methods: Related publications covering the period of 1966 to July 2014 were identified through searching MEDLINE, EMBASE, Cochrane library, Chinese Biomedical Literature Database, WANFANG, and CNKI database. A total of 17 studies were enrolled, including 6 in English and 11 in Chinese. Then, we established a final list of studies for the meta-analysis by systematically grading the quality and eligibility of the identified individual studies. We used hepatitis B antigen (HBeAg) loss, HBV-DNA undetectable rate, HBeAg seroconversion, hepatitis B surface antigen (HBsAg) loss, HBsAg seroconversion, and histological score at the end of treatment for efficacy evaluation. A quantitative meta-analysis (Review Manager, Version 5.1.0) was performed to assess the differences between NAs and IFN combination therapy and NAs monotherapy.

Results: Our analysis demonstrated that HBeAg loss (RR = 1.73, 95% CI = 1.32-2.26, p < 0.001), HBV-DNA undetectable rate (RR = 1.58, 95% CI = 1.22-2.04, p < 0.001), HBeAg seroconversion (RR = 1.68, 95% CI = 1.36-2.07, p < 0.001), and HBsAg loss (RR = 2.51, 95% CI = 1.32-4.75, p < 0.001) in the combination therapy group were significantly higher than those in the monotherapy group. However, there were no significant differences in HBsAg seroconversion (RR = 4.25, 95% CI = 0.62-29.13, p = 0.14), sustained virological response rates, and biochemical response rates observed between the two groups. The results showed that the combination therapy group had more improved HBV histology than the NAs monotherapy group (RR = 1.14, 95% CI = 0.93-1.39, p = 0.22).

Conclusions: NAs and IFN or Peg-IFN combination therapy had a better efficacy in terms of HBeAg loss, HBV-DNA undetectable rate, HBeAg seroconversion, and HBsAg loss, compared to the NA monotherapy group at the end of treatment; however, there was no significant difference in HBsAg seroconversion between the two regimens.

No MeSH data available.


Related in: MedlinePlus

Forest plot of the serum HBV-DNA undetectable rate of combination therapy group vs. nucleoside analogues monotherapy (Lam/ETV/Adv) group. The highest serum HBV-DNA undetectable rate was obtained in the combination therapy group compared with Lam. The risk ratio was 1.87 (95% CI = 1.38–2.54, p < 0.001). The higher serum HBV-DNA undetectable rate was obtained in the combination therapy group compared with Adv. The risk ratio was 1.75 (95% CI = 1.32–2.33, p < 0.001). A significant difference was found between patients in the combination group and ETV group. The risk ratio was 1.64 (95% CI = 1.34–2.01, p < 0.001).
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ijerph-12-10039-f003: Forest plot of the serum HBV-DNA undetectable rate of combination therapy group vs. nucleoside analogues monotherapy (Lam/ETV/Adv) group. The highest serum HBV-DNA undetectable rate was obtained in the combination therapy group compared with Lam. The risk ratio was 1.87 (95% CI = 1.38–2.54, p < 0.001). The higher serum HBV-DNA undetectable rate was obtained in the combination therapy group compared with Adv. The risk ratio was 1.75 (95% CI = 1.32–2.33, p < 0.001). A significant difference was found between patients in the combination group and ETV group. The risk ratio was 1.64 (95% CI = 1.34–2.01, p < 0.001).

Mentions: Serum HBV-DNA undetectable rates were reported among 13 studies, which provided both the number and the percentage of patients with undetectable HBV DNA. The virological response was analyzed individually among three subgroups based on the NAs modality. The highest serum HBV-DNA undetectable rate was found in the Lam combination therapy group compared with IFN, with a risk ratio of 1.87 (95% CI = 1.38–2.54, p < 0.001). The highest serum HBV-DNA undetectable rate was detected in the Adv combination therapy group, with a risk ratio of 1.75 (95% CI = 1.32–2.33, p < 0.001). A significant difference was found between the ETV combination group and the monotherapy group, with a risk ratio of 1.64 (95% CI = 1.34–2.01, p < 0.001) (Figure 3).


A Better Antiviral Efficacy Found in Nucleos(t)ide Analog (NA) Combinations with Interferon Therapy than NA Monotherapy for HBeAg Positive Chronic Hepatitis B: A Meta-Analysis.

Wei W, Wu Q, Zhou J, Kong Y, You H - Int J Environ Res Public Health (2015)

Forest plot of the serum HBV-DNA undetectable rate of combination therapy group vs. nucleoside analogues monotherapy (Lam/ETV/Adv) group. The highest serum HBV-DNA undetectable rate was obtained in the combination therapy group compared with Lam. The risk ratio was 1.87 (95% CI = 1.38–2.54, p < 0.001). The higher serum HBV-DNA undetectable rate was obtained in the combination therapy group compared with Adv. The risk ratio was 1.75 (95% CI = 1.32–2.33, p < 0.001). A significant difference was found between patients in the combination group and ETV group. The risk ratio was 1.64 (95% CI = 1.34–2.01, p < 0.001).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4555327&req=5

ijerph-12-10039-f003: Forest plot of the serum HBV-DNA undetectable rate of combination therapy group vs. nucleoside analogues monotherapy (Lam/ETV/Adv) group. The highest serum HBV-DNA undetectable rate was obtained in the combination therapy group compared with Lam. The risk ratio was 1.87 (95% CI = 1.38–2.54, p < 0.001). The higher serum HBV-DNA undetectable rate was obtained in the combination therapy group compared with Adv. The risk ratio was 1.75 (95% CI = 1.32–2.33, p < 0.001). A significant difference was found between patients in the combination group and ETV group. The risk ratio was 1.64 (95% CI = 1.34–2.01, p < 0.001).
Mentions: Serum HBV-DNA undetectable rates were reported among 13 studies, which provided both the number and the percentage of patients with undetectable HBV DNA. The virological response was analyzed individually among three subgroups based on the NAs modality. The highest serum HBV-DNA undetectable rate was found in the Lam combination therapy group compared with IFN, with a risk ratio of 1.87 (95% CI = 1.38–2.54, p < 0.001). The highest serum HBV-DNA undetectable rate was detected in the Adv combination therapy group, with a risk ratio of 1.75 (95% CI = 1.32–2.33, p < 0.001). A significant difference was found between the ETV combination group and the monotherapy group, with a risk ratio of 1.64 (95% CI = 1.34–2.01, p < 0.001) (Figure 3).

Bottom Line: We used hepatitis B antigen (HBeAg) loss, HBV-DNA undetectable rate, HBeAg seroconversion, hepatitis B surface antigen (HBsAg) loss, HBsAg seroconversion, and histological score at the end of treatment for efficacy evaluation.However, there were no significant differences in HBsAg seroconversion (RR = 4.25, 95% CI = 0.62-29.13, p = 0.14), sustained virological response rates, and biochemical response rates observed between the two groups.NAs and IFN or Peg-IFN combination therapy had a better efficacy in terms of HBeAg loss, HBV-DNA undetectable rate, HBeAg seroconversion, and HBsAg loss, compared to the NA monotherapy group at the end of treatment; however, there was no significant difference in HBsAg seroconversion between the two regimens.

View Article: PubMed Central - PubMed

Affiliation: Clinical Epidemiology and Evidence-based Medicine Center, Beijing Friendship Hospital, Capital Medical University, 95 Yong-An Road, Beijing 100050, China. vivi_0306@126.com.

ABSTRACT

Background: The clinical efficacy of nucleos(t)ide analogues (NAs) combined with interferon (IFN) therapy vs. NAs monotherapy for chronic hepatitis B (CHB) remains inconclusive. The aim of this meta-analysis was to determine whether the NAs plus IFN regimen offers synergistic efficacy that justifies the cost and burden of such a combination therapy in CHB patients.

Methods: Related publications covering the period of 1966 to July 2014 were identified through searching MEDLINE, EMBASE, Cochrane library, Chinese Biomedical Literature Database, WANFANG, and CNKI database. A total of 17 studies were enrolled, including 6 in English and 11 in Chinese. Then, we established a final list of studies for the meta-analysis by systematically grading the quality and eligibility of the identified individual studies. We used hepatitis B antigen (HBeAg) loss, HBV-DNA undetectable rate, HBeAg seroconversion, hepatitis B surface antigen (HBsAg) loss, HBsAg seroconversion, and histological score at the end of treatment for efficacy evaluation. A quantitative meta-analysis (Review Manager, Version 5.1.0) was performed to assess the differences between NAs and IFN combination therapy and NAs monotherapy.

Results: Our analysis demonstrated that HBeAg loss (RR = 1.73, 95% CI = 1.32-2.26, p < 0.001), HBV-DNA undetectable rate (RR = 1.58, 95% CI = 1.22-2.04, p < 0.001), HBeAg seroconversion (RR = 1.68, 95% CI = 1.36-2.07, p < 0.001), and HBsAg loss (RR = 2.51, 95% CI = 1.32-4.75, p < 0.001) in the combination therapy group were significantly higher than those in the monotherapy group. However, there were no significant differences in HBsAg seroconversion (RR = 4.25, 95% CI = 0.62-29.13, p = 0.14), sustained virological response rates, and biochemical response rates observed between the two groups. The results showed that the combination therapy group had more improved HBV histology than the NAs monotherapy group (RR = 1.14, 95% CI = 0.93-1.39, p = 0.22).

Conclusions: NAs and IFN or Peg-IFN combination therapy had a better efficacy in terms of HBeAg loss, HBV-DNA undetectable rate, HBeAg seroconversion, and HBsAg loss, compared to the NA monotherapy group at the end of treatment; however, there was no significant difference in HBsAg seroconversion between the two regimens.

No MeSH data available.


Related in: MedlinePlus