Peginterferon Treatment For HBeAg-positive Chronic Hepatitis B: A Meta-analysis

OBJECTIVEThe efficacy and safety of peginterferon treatment for HBeAg-positive chronic hepatitis B were systematically evaluated.METHODSMEDLINE (1994.01～2010.12), EMBASE (1994.01～2010. 12), The Cochrane Central Register of Controlled Trials (The Cochrane Library,1994.01～2010.12), CNKI(1994.01～2010.12), VIP(1994.01～2010.12) and WanFang Data (1994.01～2010.12) were searched, and we hand searched 4 journals:Chinese Journal of Internal Medicine, Chinese Journal of Hepatology, Chinese Journal of Digestion and Chinese Journal of Infectious Diseases. References of included literatures were also followed. Two investigators selected trials based on including and excluding criteria, assessed quality of literature and extracted data independently. Then Meta-analysis was done with RevMan 5.0.RESULTS9 researches of 10 literatures were included. The results of our Meta-analysis demonstrated that, for HBeAg-positive chronic hepatitis B, combination therapy for 1 year of peginterferon and lamivudine can achieve higher rate of HBV DNA loss(P< 0.00001,95%CI=[4.32, 8.35])and rate of ALT normalization (P=0.002<0.05,95% CI=[1.18,2.06]) at the end of treatment, compared to pepeginterferon monotherapy. Comparing with lamivudine monotherapy for 1 year, combination of peginterferon and lamivudine can achieve higher rate of HBV DNA loss(P=0.01<0.05,95%CI=[1.35,15.94]) at the end of treatment. The rate of HBV DNA loss (P=0.001<0.05,95%CI=[1.44,4.38]) and ALT normalization (P=0.001<0.05,95%CI=[1.16,1.80]) are also higher than lamivudine monotherapy after half years of follow-up.For lamivudine-resistant chronic hepatitis B, peginterferon monotherapy for 1 year can achieve higher rate of HBeAg loss (P=0.003<0.05,95%CI=[1.32,4.13]) and HBeAg seroconversion (P=0.001<0.05,95%CI=[1.68,8.37]) at the end of treatment, compared to adefovir dipivoxil monotherapy.Comparing with entecavir monotherapy, peginterferon monotherapy for 1 year can achieve higher rate of HBeAg loss(P=0007<0.05, 95%CI=[1.90,10.81]) and HBeAg seroconversion (P=0.002<0.05, 95%CI=[1.71,10.55]) at the end of treatment.Peginterferon monotherapy or combination therapy of peginterferon and lamivudine can induce higher rates of adverse events than nucleos(t)ide analogues, although these common adverse events are transient. CONCLUTIONFor HBeAg-positive chronic hepatitis B, combination therapy of peginterferon and lamivudine has some advantages on reduction of HBV DNA and ALT normalization. Comparing with adefovir dipivoxil or entecavir, peginterferon can achieve higher rate of HBeAg loss and HBeAg seroconversion. The incidence of adverse events during peginterferon therapy is relatively high.