Introduction Stopping rules have been proposed for the early discontinuation of Pegylated-Interferon-α (PEG-IFN-α) therapy in those patients who are considered unlikely to respond. Recent studies have shown that no reduction in quantitative HBsAg and the absence of >2 log decline in HBV DNA at 12 weeks therapy can predict non-response. However, these data are almost exclusively from genotype A and D cohorts. Here we test how robust this strategy would be in clinical practice and whether this rule could be applied to a UK population of diverse HBV genotypes.
Methods 49 patients (male=35) were treated with PEG-IFNα for CHB over the course of the study. Ten patients remain on therapy and eight patients discontinued due to poor compliance or intolerance. 31 patients (male=20), HBeAg positive (n=24), median age 31 (range 18–55) completed 48 weeks PEG-IFNα and were included in the analysis. HBV genotype was recorded for all patients (A=6, B=5, C=10, D=9, E=1). ALT, HBV DNA and HBsAg was quantified at baseline and longitudinally at 12-week intervals.
Results Of the 31 patients, 10 were considered responders; seven were HBeAg positive and seroconverted on therapy and three were HBeAg negative pre-therapy and considered responders with sustained immune control off treatment. The decline in HBV DNA and qHBsAg by 12 weeks was 3.99 log, 0.17 log (HBeAg positive group) and 2.9 log, 0.5 log (HBeAg negative group) respectively. 16/31 patients were non-genotype A or D. Of the responders from this group there was a decline in HBV DNA and qHBsAg of 4.10 log and 0.58 log respectively by 12 weeks. On sub-group analysis by genotype, there was no statistically significant difference in HBV DNA and qHBsAg decline at 12 weeks across all genotypes, when comparing HBV DNA and qHBsAg between genotype A and D and non A and D patients (p=0.40 and 1.0 respectively). More over adopting the rule of >2 log decline in HBV DNA and no decline in qHBsAg by 12 weeks, reveals we would not exclude those likely to respond; as all responders achieve the outlined viral response by 12 weeks therapy.
Conclusion These data highlight the utility of this stopping rule for PEG-IFNα across all genotypes. The absence of >2 log decline in HBV DNA and reduction in qHBsAg at 12 weeks therapy makes a favourable response unlikely. This rule should be adopted in clinical practice to avoid poorly tolerated side effects and the cost of completing 48 weeks therapy. Furthermore, this 12-week milestone would allow the early switch to an oral antiviral in PEG-IFNα non-responders.
Competing interests None declared.
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