The treatment of hepatitis B e antigen-positive chronic hepatitis B with pegylated interferon

Abstract

Interferons were first used in the treatment of chronic hepatitis B two decades ago [1–3] and eventually led to the registration of this drug in the treatment of chronic hepatitis B. The interferons act as immunomodulators having a number of effects on the immune system and also act as an antiviral agent by inducing oligoadenylate synthetase and other proteins which lead to cleavage of viral RNA. Although there was increasing efficacy with the dose of interferon achieving better results using 9 mIU per square metre of body surface area three times a week, the significant side effects caused withdrawal in many patients. There was a variety of other dose regimens including a daily dose of half the amount. The dose recommended was 2.5 mIU or 5 mIU per square metre three times a week. This translated into 4.5/5 or 9/10 mIU three times a week. Furthermore, the side effects, often described as an influenza-like illness of myalgia, fever and headache, occurred in most patients and there were a plethora of other side effects, including mood changes and even depression. The seroconversion rate in patients who had hepatitis B e antigen (HBeAg)-positive chronic hepatitis B ranged from 20 to 50% of patients who had a 6-month course of treatment.