Meta-analysis on nucleos(t)ide analogue monotherapy or nucleos(t)ide analogue/interferon sequential thera-py for chronic hepatitis B

Abstract

Objective To evaluate the efficacy of nucleos (t) ide analogues (NAs) and interferon (IFN) sequential therapy versus NAs monotherapy for CHB, and to further explore the optimal therapeutic treatment. Methods The meta-analysis of the included 24 articles was performed by Review Manager Software 5.3. ALT normalization rate, HBV DNA undetectable rate, HBeAg and HBsAg loss rate, HBeAg and HBsAg seroconversion rate were measured. Results At the end of the treatment, patients who had received sequential therapy had higher rates of ALT normalization, HBV DNA negative conversion, HBeAg negative conversion, HBeAg conversion, HBsAg negative conversion and HBsAg conversion, which were 83.9%, 78.4%, 47.2%, 41.6%, 9.1%, and 5.6% respectively, than those in NAs monotherapy group which were 68.6%, 67.3%, 26.8%, 17.3%, 0 and 0 (RR=1.18, 1.13, 1.73, 2.33, 9.86 and 6.58, P all<0.01) . At the end of treatment, rates of ALT normalization, HBV DNA negtive conversion and HBeAg negtive conversion were 84.4%, 81.9% and 85.0%, which were higher than 74.1%, 63.1% and 50.0% respectively during follow-up visit (RR=1.14, 1.26 and 1.61, P all<0.01) . According to the different duration of IFN therapy (≥48 weeks and<48 weeks) , the results showed that those at the rates of ALT normalization and HBV DNA negative conversion were higher at the end of treatment than those at the end of follow-up (84.4% vs 73.1%, 81.0% vs 63.4%,RR=1.16 and 1.24) in IFN therapy <48 weeks group. Conclusions At the end of treatment, all indexes in the sequential therapy group are better than those in NAs monotherapy group. Patients with IFN therapeutic duration <48 weeks have a high risk of HBV may reactivation after long-term drug withdrawal. Key words: Chronic hepatitis B; Nucleos (t) ide analogues; Interferon; Sequential therapy