Effect of Alpha-Interferon Treatment in Patients with Hepatitis B e Antigen-Positive Chronic Hepatitis B

doi:10.1059/0003-4819-119-4-199308150-00011

Effect of Alpha-Interferon Treatment in Patients with Hepatitis B e Antigen-Positive Chronic Hepatitis B

A Meta-Analysis

From the Toronto Hospital and the Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario. Requests for Reprints: Jenny Heathcote, MD, 399 Bathurst Street, ECW 7-006, Toronto, Ontario M5T 2S8, Canada. Acknowledgments: The authors thank Dr. Edward Etchells and Dr. David Naimark for assessing the quality of the studies used in our meta-analysis and Drs. A. Lok, R. Muller, G. Pastore, M. Sabbour, and G. Saracco for providing additional information about their studies. Grant Support: Dr. Detsky is supported by a National Health Research Scholar Award from Health and Welfare Canada. Dr. Naylor is supported by a Career Scientist Award (02387) from the Ontario Ministry of Health.

Abstract

Purpose: To determine whether -interferon is effective in terminating viral replication and in eradicating the carrier state in patients with chronic hepatitis B virus (HBV) infection.

Data Sources: Randomized controlled studies published in the English literature between January 1966 and June 1992 were identified through a MEDLINE computer search.

Study Selection: Fifteen randomized, controlled studies with a total of 837 adult chronic HBV carriers who were positive for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) were identified. Studies were included if patients were treated for at least 3 months and followed for at least 6 months after cessation of therapy.

Results: Overall, the loss of HBsAg occurred 6% more often in interferon-treated patients than the natural seroconversion seen in controls (7.8% compared with 1.8%, P = 0.001), and the loss of viral replication occurred approximately 20% more often in treated patients than in controls (33% compared with 12% for loss of HBeAg and 37% compared with 17% for the loss of HBV DNA, P = 0.0001) if patients received interferon for 3 to 6 months and were followed for 6 to 12 months. Interferon also had a significant treatment effect on the development of antibodies to HBsAg (anti-HBs), antibodies to HBeAg (anti-HBe), and on the normalization of alanine aminotransferase levels.

Conclusions: Alpha-interferon is effective in terminating viral replication and in eradicating the carrier state in patients with chronic HBV infection who are HBeAg positive when these patients are treated for 3 to 6 months and followed for 6 to 12 months after cessation of therapy. Follow-up studies are required to determine whether interferon reduces the risk for developing cirrhosis or hepatocellular carcinoma.