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Response-guided therapy of regimens based on PEG-interferon for chronic hepatitis B using on-treatment hepatitis B surface antigen quantification: a meta-analysis

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Abstract

Purpose

The efficacy of on-treatment hepatitis B surface antigen (HBsAg) levels in guiding pegylated interferon (PEG-IFN) therapy for chronic hepatitis B (CHB) infections is still controversial. The aim of this study is to quantitatively evaluate the efficacy of on-treatment HBsAg levels as a response-guided therapy strategy to guide PEG-IFN-based therapies for CHB.

Methods

We searched PUBMED, EMBASE, and the Cochrane Library (1997–2013) for clinical research involving HBsAg quantification, and the response to PEG-IFN-based therapy. Pooled effect of HBsAg levels on guiding PEG-IFN-based therapies for CHB was evaluated using fixed-effects or random-effects model.

Results

From 13 studies (n = 1493 patients), patients with optimal on-treatment HBsAg levels were found to have a greater chance of attaining a response (RR 5.17, 95 % CI 3.75–7.11, p < 0.00001), and the pooled total response rate was 54 % (95 % CI 44–63 %). At week 12, patients without optimal on-treatment HBsAg levels had hardly achieved a response (the early non-response rate: 99 %, 95 % CI 98–100 %). At 24 weeks, the response rate increased to 79 % in HBeAg-negative patients.

Conclusion

This meta-analysis suggested that on-treatment HBsAg quantification is effective in guiding the therapy of PEG-IFN in CHB infections, especially in HBeAg-negative patients.

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Acknowledgements

This research was supported by the National Natural Science Foundation of China (Nos. 30930082, 81171561, and 30972584), the National Science and Technology Major Project of China (Nos. 2008ZX10002-006 and 2012ZX10002007001), the National High Technology Research and Development Program of China (No. 2011AA020111) and the Medical Scientific Research Funds of Chinese Medical Association (No. 13071140499).

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Authors and Affiliations

  1. Department of Infectious Diseases, Institute for Viral Hepatitis, Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, Second Affiliated Hospital of Chongqing Medical University, LinjiangRoad#76, Yuzhong District, Chongqing, 400010, China

    Hong Peng, Fang Wei, Huai-Dong Hu, Hong Ren & Peng Hu

  2. Department of Infectious Diseases, The Guizhou Province People’s Hospital, Guiyang, Guizhou Province, China

    Hong Peng

  3. Department of Gastroenterology, The Central Hospital of Zhoukou, Zhoukou, Henan Province, China

    Jun-Ying Liu

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  1. Hong Peng
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Correspondence to Peng Hu.

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Conflict of interest

Hong Peng, Fang Wei, Jun-Ying Liu, Huai-Dong Hu, Hong Ren and Peng Hu declare there is no conflict of interest.

Human and animal rights statement

This study was approved by the ethics committee of our hospital. This article does not contain any studies with human or animal subjects.

Electronic supplementary material

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12072_2015_9644_MOESM1_ESM.tif

Figure S1. A Forest map of subgroup analysis for comparison of the total response rate according to HBeAg status. (TIFF 53 kb)

12072_2015_9644_MOESM2_ESM.tif

Figure S2. A Forest map for comparison of response rate of different HBeAg status at 12 weeks according to RGT. (TIFF 53 kb)

12072_2015_9644_MOESM3_ESM.tif

Figure S3. A Forest map for comparison of response rate of different HBeAg statues at 24 weeks according to RGT. (TIFF 45 kb)

12072_2015_9644_MOESM4_ESM.tif

Figure S4. An algorithm showing the chances of response based on HBsAg decline and HBV DNA decline at week 12 and 24 and corresponding treatment strategy. (TIFF 79 kb)

12072_2015_9644_MOESM5_ESM.tif

Figure S5. The total response rate of different treatment strategies (PEG-IFN combination with or without NAs) according to RGT.(A) HBeAg-positive patients, (B) HBeAg-negative patients, (C) PEG-IFN monotherapy and PEG-IFN combination with LAM or ADF/TDF according to RGT. (TIFF 665 kb)

12072_2015_9644_MOESM6_ESM.tif

Figure S6A. A funnel plot for total response rate according RGT. B. A funnel plot for early non-response rate according RGT. (TIFF 144 kb)

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Peng, H., Wei, F., Liu, JY. et al. Response-guided therapy of regimens based on PEG-interferon for chronic hepatitis B using on-treatment hepatitis B surface antigen quantification: a meta-analysis. Hepatol Int 9, 543–557 (2015). https://doi.org/10.1007/s12072-015-9644-y

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