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Early HBeAg Loss During Peginterferon α-2b Therapy Predicts HBsAg Loss

Results of a Long-Term Follow-Up Study in Chronic Hepatitis B Patients

Buster, Erik H.C.J., MD1; Flink, Hajo J., MD, PhD1; Simsek, Halis, MD, PhD2; Heathcote, Jenny E., MD, PhD3; Sharmila, Sachithanandan, MD, PhD4; Kitis, George E., MD, PhD5; Gerken, Guido, MD, PhD6; Buti, Maria, MD, PhD7; de Vries, Richard A., MD, PhD8; Verhey, Elke, BSc1; Hansen, Bettina E., MSc1,9; Janssen, Harry L.A., MD, PhD1

American Journal of Gastroenterology: October 2009 - Volume 104 - Issue 10 - p 2449–2457
ORIGINAL CONTRIBUTIONS: LIVER AND BILIARY TRACT
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OBJECTIVES: Treatment with pegylated interferon (PEG-IFN) α-2b results in hepatitis B e antigen (HBeAg) loss in 36% of patients at 6 months post treatment. The aim of this study was to determine whether a long-term response to PEG-IFN is dependent on the timing of HBeAg loss.

METHODS: A total of 91 patients treated with PEG-IFN α-2b alone (100 μg per week) and 81 patients treated with PEG-IFN α-2b and lamivudine (100mg/day) for 52 weeks were enrolled in this study. Patients were initially followed up at 4-week intervals and had one additional long-term follow-up (LTFU) visit (mean: 3.03±0.77 years 26 weeks post treatment).

RESULTS: Of the 172 patients included, 78 patients (46%) did not have loss of HBeAg, 47 (27%) lost HBeAg within 32 weeks, and 47 patients (27%) had loss of HBeAg after week 32. At LTFU, patients with HBeAg loss ≤32 weeks had hepatitis B virus DNA of <400copies/ml significantly more often than did those who lost HBeAg after week 32 (47 vs. 21%, respectively;P=0.009). Hepatitis B surface antigen (HBsAg) negativity was also observed significantly more often in patients with early HBeAg loss (36 vs. 4%, respectively,P<0.001). Early HBeAg loss tended to occur more often in patients treated with PEG-IFN and lamivudine combination therapy than in those treated with PEG-IFN alone (35 vs. 21%;P=0.10), as did HBsAg loss (15 vs. 8%;P=0.14).

CONCLUSIONS: Early PEG-IFN-induced HBeAg loss results in a high likelihood of HBsAg loss and may be associated with more profound viral suppression during the first 32 weeks of therapy in patients treated with lamivudine combinations.

Am J Gastroenterol 2009; 104:2449-2457; doi:10.1038/ajg.2009.371; published online 7 July 2009

1Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands; 2Hacettepe University Faculty of Medicine, Ankara, Turkey; 3Department of Medicine, Toronto Western Hospital University Health Network, Toronto, Canada; 4Hepatology Unit, Hospital Selayang, Selangor, Malaysia; 5Department of Gastroenterology, George Papanikolaou General Regional Hospital, Thessaloniki, Greece; 6Department of Gastroenterology and Hepatology, University Hospital, Essen, Germany; 7Liver Unit, Hospital General Universitari Vall d'Hebron and CIBEREHD, Barcelona, Spain; 8Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands; 9Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands. Correspondence: Harry L.A. Janssen, MD, PhD, Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam's Gravendijkwal 230, Room Ha204, 3015 CE Rotterdam, The Netherlands.

E-mail: h.janssen@erasmusmc.nl

Received 28 August 2008; accepted 7 May 2009

© The American College of Gastroenterology 2009. All Rights Reserved.
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