Add-on peg-interferon accelerates hepatitis B antigen loss

Use of pegylated interferon alpha 2a (P-IFN) as an add-on therapy in chronic hepatitis B patients on tenofovir disoproxil fumarate (TDF) facilitates rapid reductions in hepatitis B surface antigen (HBsAg) and core-related antigen (HBcrAg) levels, a study has shown.

In total, 83 patients (63 percent male) on maintenance TDF and having HBsAg level >800 IU/ml were randomized to receive add-on P-IFN (n=32; mean age, 43.3 years) for 48 weeks or maintain TDF monotherapy (n=51; mean age, 45.7 years). Both groups were followed for 96 weeks.

At baseline, HBsAg was positive in 14 patients in the add-on arm and in 18 the control arm. Moreover, HBsAg seroconversion occurred more frequently in the add-on arm (43 percent vs 28 percent), although the difference was not significant. HBsAg, HBcrAg, and HBV DNA levels were all similar in the two arms.

Nearly all patients in the control arm exhibited a slow and constant reduction in HBsAg during follow-up. On the contrary, roughly half of those in the add-on arm exhibited a sharp decline in HBsAg during P-IFN treatment, which disappeared after cessation.

At 96 weeks, more patients in the add-on than in the control arm had shown a rapid decrease in HBsAg (41 percent vs 2 percent; p<0.001) and HBcrAg levels (62 percent vs 31 percent; p=0.023).

On multivariate logistic regression analysis, add-on therapy and increased cytotoxic T-cell response predicted a rapid decrease in HBsAg. Meanwhile, higher HBcrAg level at baseline and add-on therapy factored in a rapid reduction in HBcrAg.