Bikrant Bihari Lal1, Vikrant Sood1, Rajeev Khanna1, Dinesh Rawat1, Sanjeev Verma1, Seema Alam2. 1. Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110 070, India. 2. Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110 070, India. seema_alam@hotmail.com.
Abstract
BACKGROUND: Our aim was to evaluate the efficacy and safety of sequential therapy using pegylated interferon (Peg-IFN) and nucleos(t)ide analogue (NA) for treatment of children in immunoactive (IA) and immunotolerant (IT) phases of chronic hepatitis B. METHODS: It was a prospective observational study where those willing for sequential therapy were allocated to group 1 (sequential therapy) and others to group 2 (standard therapy). Sequential therapy included 8 weeks of NA followed by 44 weeks of combination of NA and Peg-IFN. In group 2, IA children received NA monotherapy, and IT children received no therapy. HBe seroconversion, HBs seroconversion, and loss of HBV DNA were the major outcome measures. RESULTS: A total of 61 children (36 IA and 25 IT) were included in the analysis. Among the IA children, 17 received sequential therapy and 19 received standard therapy; whereas, among the IT children, 12 received sequential therapy and 13 did not receive any therapy. In IA phase, sequential therapy led to higher HBe seroconversion (64.7% vs. 21.05%, p = 0.017) and higher virological clearance (94.12% vs. 52.63%, p = 0.008). In IT children, there was no benefit of treatment with sequential therapy over observation alone. Baseline ALT > 100 IU/L predicted response to therapy with 100% sensitivity, 89.5% specificity, and LR+ of 9.52. CONCLUSION: Sequential therapy leads to higher HBe seroconversion and virological response in children in IA phase. Children with baseline ALT > 100 IU/mL are more likely to respond to sequential therapy. There appears to be no role of sequential therapy in children in IT phase.
BACKGROUND: Our aim was to evaluate the efficacy and safety of sequential therapy using pegylated interferon (Peg-IFN) and nucleos(t)ide analogue (NA) for treatment of children in immunoactive (IA) and immunotolerant (IT) phases of chronic hepatitis B. METHODS: It was a prospective observational study where those willing for sequential therapy were allocated to group 1 (sequential therapy) and others to group 2 (standard therapy). Sequential therapy included 8 weeks of NA followed by 44 weeks of combination of NA and Peg-IFN. In group 2, IA children received NA monotherapy, and IT children received no therapy. HBe seroconversion, HBs seroconversion, and loss of HBV DNA were the major outcome measures. RESULTS: A total of 61 children (36 IA and 25 IT) were included in the analysis. Among the IA children, 17 received sequential therapy and 19 received standard therapy; whereas, among the IT children, 12 received sequential therapy and 13 did not receive any therapy. In IA phase, sequential therapy led to higher HBe seroconversion (64.7% vs. 21.05%, p = 0.017) and higher virological clearance (94.12% vs. 52.63%, p = 0.008). In IT children, there was no benefit of treatment with sequential therapy over observation alone. Baseline ALT > 100 IU/L predicted response to therapy with 100% sensitivity, 89.5% specificity, and LR+ of 9.52. CONCLUSION: Sequential therapy leads to higher HBe seroconversion and virological response in children in IA phase. Children with baseline ALT > 100 IU/mL are more likely to respond to sequential therapy. There appears to be no role of sequential therapy in children in IT phase.
Authors: W P Brouwer; M J Sonneveld; Q Xie; S Guo; N Zhang; S Zeuzem; F Tabak; Q Zhang; K Simon; U S Akarca; A Streinu-Cercel; B E Hansen; H L A Janssen Journal: J Viral Hepat Date: 2015-09-25 Impact factor: 3.728
Authors: Erik H C J Buster; Bettina E Hansen; George K K Lau; Teerha Piratvisuth; Stefan Zeuzem; Ewout W Steyerberg; Harry L A Janssen Journal: Gastroenterology Date: 2009-09-06 Impact factor: 22.682
Authors: Patrick Marcellin; Sang Hoon Ahn; Xiaoli Ma; Florin A Caruntu; Won Young Tak; Magdy Elkashab; Wan-Long Chuang; Seng-Gee Lim; Fehmi Tabak; Rajiv Mehta; Joerg Petersen; Graham R Foster; Lillian Lou; Eduardo B Martins; Phillip Dinh; Lanjia Lin; Amoreena Corsa; Prista Charuworn; G Mani Subramanian; Hans Reiser; Hendrick W Reesink; Scott Fung; Simone I Strasser; Huy Trinh; Maria Buti; Giovanni B Gaeta; Aric J Hui; George Papatheodoridis; Robert Flisiak; Henry L Y Chan Journal: Gastroenterology Date: 2015-10-08 Impact factor: 22.682