A Meta-Analysis of the Efficacy of Interferon Monotherapy or Combined with Different Nucleos(t)ide Analogues for Chronic Hepatitis B.

Jialing Zhou,Wei Wei,Hong You,Jidong Jia,Xiaoning Wu,Yuanyuan Kong

doi:10.3390/ijerph13070730

Abstract

Background: The aim of the present study was to compare the efficacy of interferon (IFN) with or without different nucleos(t)ide analogues (NAs). Methods: The PubMed, Wan Fang and CNKI databases were searched to identify relevant trials up to May 2015. Meta-analysis was performed with Review Manager 5.0. The stability and reliability were evaluated by publication bias tests. Results: Fifty-six studies fulfilled the criteria for the meta-analysis. Compared with IFN monotherapy, combination therapy were superior in HBV DNA undetectable rate (Risk Ratio (RR) = 1.55, 95% confidence interval (CI): 1.44–1.66, p < 0.00001), HBeAg and HBsAg loss rate (RR = 1.38, 95% CI: 1.22–1.56, p < 0.00001; RR = 1.69, 95% CI: 1.03–2.78, p = 0.04, respectively) at the end of week 48 treatment. Sub-analysis showed the RRs of virological response for entecavir (ETV), adefovir (ADV), and lamivudine (LAM) were 1.64, 1.61 and 1.52, respectively; RRs of HBeAg loss rate were 1.34, 1.71 and 1.34, respectively. However, at the end of follow-up, IFN plus NAs therapy was better than IFN monotherapy only in terms of HBV DNA undetectable rate (p = 0.0007). Conclusions: Combination therapy was better than IFN monotherapy in virological and serological responses at the end of treatment. After follow-up, only HBV DNA undetectable rate was superior for combination therapy.

Highlights

Chronic hepatitis B virus (HBV) infection is a severe burden on public health
Plus ADV resulted in better virological suppression [13], whereas lamivudine combination therapy was likely to be or less efficacious than pegylated interferon monotherapy [18]
We found that at treatment week 48, ETV combination therapy yield slightly better virological response than other combination therapies

Summary

Introduction

Chronic hepatitis B virus (HBV) infection is a severe burden on public health. Current consensus guidelines on CHB recommend either a finite course of PEG IFN which stimulates immune response against the virus [1,2] or NA treatment of indefinite duration which directly suppresses replication of HBV [3–5].the efficacy of monotherapy with IFN or NAs has been unsatisfactory. Current consensus guidelines on CHB recommend either a finite course of PEG IFN which stimulates immune response against the virus [1,2] or NA treatment of indefinite duration which directly suppresses replication of HBV [3–5]. NAs directly inhibit viral replication by targeting HBV DNA, while IFN is an important immuno-modulator that interacts with the adaptive and innate immune responses, and has limited direct antiviral effect on HBV [6,7]. Combining NAs and IFN, with their different mechanisms of action, is an attractive therapeutic regimen for treating CHB. The combination therapies using NAs and IFN have been extensively studied with a rationale that they may have synergistic antiviral effects. The aim of the present study was to compare the efficacy of interferon (IFN). Results: Fifty-six studies fulfilled the criteria for the meta-analysis.

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Discussion

Conclusion