Add-on, switch-to PEG-IFN therapy strategies improve serological response in CHB patients

Chronic hepatitis B (CHB) patients, who have virological response with long-term entecavir (ETV) treatment, appear to fare well with a strategy of adding or switching to peginterferon (PEG-IFN) therapy, as shown in a study.

Both approaches result in improved hepatitis B e antigen (HBeAg) seroconversion and hepatitis B surface antigen (HBsAg) reduction relative to continuous ETV monotherapy.

The multicentre, parallel, open-label study included 153 HBeAg-positive CHB patients on ETV treatment ≥2 years, HBsAg <3,000 IU/ml, HBeAg <200 S/CO, and HBV DNA <50 IU/ml. They were randomized to receive PEG-IFN as an add on (n=50), switch to PEG-IFN (n=52), or continue ETV monotherapy (n=51) for 48 weeks.

The primary endpoint of HBeAg seroconversion at week 48 occurred with significantly greater frequency in both the add-on and switch-to groups than in the continuous ETV group (18.0 percent and 19.2 percent vs 2.0 percent; p=0.007 and p=0.005, respectively).

A similar pattern of results was observed for HBeAg loss (24.0 percent and 23.1 percent vs 5.9 percent; p=0.010 and p=0.013, respectively), HBsAg <100 IU/ml (30.0 percent and 34.6 percent vs 0 percent; p<0.001 for both), and HBsAg reduction (−0.90 and −0.92 vs −0.06 log₁₀IU/ml; p<0.001 for both) at week 48. Efficacy did not significantly differ between the add-on and switch-to groups (p>0.05).

Adverse events were mainly related to PEG-IFN but generally tolerable.