Switching to or Add-on Peginterferon in Patients on Nucleos(t)ide Analogues for Chronic Hepatitis B: The SWAP RCT
| Autor: | Amy Tay, Chris Lee, Taufique Ahmed, Htet Htet Toe Wai Khine, Wei Lyn Yang, Seng Gee Lim, Khin Lay Wai, Edwin Chan, W. W. Phyo, Jason Chang, Poh Seng Tan, Yock Young Dan, Kieron B. Lim, Jessica Tan, Guan Huei Lee, Jing Hieng Ngu, Yin Mei Lee |
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| Rok vydání: | 2022 |
| Předmět: |
Hepatitis B virus
HBsAg medicine.medical_specialty medicine.disease_cause Antiviral Agents Gastroenterology Polyethylene Glycols law.invention 03 medical and health sciences Hepatitis B Chronic 0302 clinical medicine Randomized controlled trial law Pegylated interferon Internal medicine medicine Clinical endpoint Humans Hepatitis B e Antigens Hepatitis B Surface Antigens Intention-to-treat analysis Hepatology Nucleoside analogue business.industry Interferon-alpha virus diseases Treatment Outcome HBeAg 030220 oncology & carcinogenesis DNA Viral 030211 gastroenterology & hepatology business medicine.drug |
| Zdroj: | Clinical Gastroenterology and Hepatology. 20:e228-e250 |
| ISSN: | 1542-3565 0192-8511 |
| Popis: | The optimal therapeutic strategy in nucleoside analogue (NA) experienced chronic hepatitis B (CHB) using peginterferon is still unclear; hence we explored a switch to or add-on peginterferon strategy versus continued NA.We conducted a randomized controlled trial of CHB patients on NA12 months with HBV DNA(-) randomized to switch or add-on peginterferon-alpha2b (1.5 μg/kg/weekly) for 48 weeks versus continuing NA (controls) (allocation 2:2:1; Clinicaltrial.gov: NCT01928511) in tertiary Singapore hospitals. The primary composite endpoint at week 72 was hepatitis B e antigen (HBeAg) loss or quantitative HBsAg (qHBsAg)1 log IU/mL reduction, and secondary endpoints were HBsAg loss, HBsAg seroconversion, qHBsAg200 IU/mL, qHBsAg100 IU/mL, HBV DNA(-), viral relapse, and safety. Analysis was by intention-to-treat (ITT).A total of 253 patients (controls 51, switch 103, add-on 99) were randomized. The primary ITT endpoint was achieved in 3.9% of controls, 33.3% of switch, and 26.7% of add-on (P.0001, switch/add-on versus controls). HBsAg loss occurred in 0% of controls, 7.8% of switch, and 10.1% of add-on (ITT, P.001, switch/add-on versus controls). HBeAg(+) patients on peginterferon had higher HBeAg loss than controls but poor HBsAg responses, whereas HBeAg(-) patients on peginterferon achieved better HBsAg responses than controls. Reduction in qHBsAg in HBeAg(+) was 0.14 log IU/mL versus 0.51 log IU/mL in HBeAg(-) (P.0001) in peginterferon-treated patients. Clinical relapse was higher in switch (13.6% overall, 27% in HBeAg(+)) versus 1% add-on and 0% controls. Adverse events were typically interferon-related symptoms, with one death (myocardial infarction unrelated to therapy).ITT analysis showed that either peginterferon strategies were superior to NA for the primary endpoint and HBsAg loss, but add-on peginterferon is preferred to switch due to improved safety and similar efficacy. ClincialTrials.gov number: NCT01928511. |
| Databáze: | OpenAIRE |
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