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Peginterferon therapy for chronic hepatitis B: one size fits all?
  1. Henry Lik-Yuen Chan
  1. Correspondence to Dr Henry Lik-Yuen Chan, Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong, 9/F Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China; hlychan{at}cuhk.edu.hk

https://doi.org/10.1136/gutjnl-2012-303291

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    Interferon: a finite course of antiviral treatment

    The disease of chronic hepatitis B hinges on a balance between the virus and the host immune system. Clearance of hepatitis B virus (HBV) relies on the host immunity. On the other hand, liver necroinflammation and cirrhosis occurs when there is persistent, yet unsuccessful, immune clearance of the virus.1 Interferon is the first registered drug for the treatment of chronic hepatitis B. It is an immune modulator with weak antiviral property. Its main function is to augment the host immune clearance of the virus. Hence interferon works best when the host is in the immune clearance phase with elevated liver enzymes and low HBV DNA.2 One major advantage of interferon is the finite treatment course, which can potentially lead to sustained remission of disease in the subsequent decades.3 Long-term follow-up studies have confirmed a reduction in risk of liver-related complications, hepatocellular carcinoma and liver-related mortality among sustained interferon responders.4 ,5

    Interferon treatment: how long is enough?

    Since the mid-1980s, the standard duration of interferon has been 16–24 weeks. Although some evidence suggested that prolonged interferon to 32 weeks might improve the response,6 24 weeks was still the recommended duration for hepatitis B e antigen (HBeAg)-positive patients in regional guidelines.7 ,8 Early studies of peginterferon have used 32-week peginterferon, with or without lamivudine combination, with satisfactory results.9 ,10 In the pivotal of studies of peginterferon, all patients received 48–52 weeks of treatment.11–13 The standard treatment duration of peginterferon for chronic hepatitis B was then set to 48 weeks in both HBeAg-positive and HBeAg-negative patients.7 ,14 The evidence to support the use of 48-week over 24-week peginterferon was only available half a decade after its global registration for this indication.15 In this study (the NEPTUNE study), peginterferon α-2a at a standard dose of 180 mcg/week for 48 weeks was associated with …

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    Footnotes

    • Competing interests HLY Chan is a consultant and has received honorarium for lectures from Abbott, Bristol Myers Squibb, Gilead, Merck, Novartis Pharmaceutical and Roche, and has received an unrestricted grant from Roche for hepatitis B virus research.

    • Provenance and peer review Commissioned; internally peer reviewed.

    Linked Articles

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      Randomised study comparing 48 and 96 weeks peginterferon α-2a therapy in genotype D HBeAg-negative chronic hepatitis B
      Pietro Lampertico Mauro Viganò Giovan Giuseppe Di Costanzo Evangelista Sagnelli Massimo Fasano Vito Di Marco Sara Boninsegna Patrizia Farci Silvia Fargion Tiziana Giuberti Claudio Iannacone Loredana Regep Benedetta Massetto Floriana Facchetti Massimo Colombo on behalf of the PegBeLiver Study Group Pietro Andreone Anna Riili Alessandra Scuteri Carmela Cursaro Angelo Andriulli Grazia Anna Niro Gioacchino Angarano Massimo Fasano Teresa Antonia Santantonio Maria Stefania Palattella Maurizia Brunetto Piero Colombatto Barbara Coco Pietro Ciccorossi Filippo Oliveri Rodolfo Sacco Savino Bruno Simona Bollani Alberto Chiesa Giampiero Carosi Chiara Baiguera Stefania Rossi Serena Zaltron Massimo Puoti Massimo Colombo Pietro Lampertico Raffaele Cozzolongo Vito Giannuzzi Antonio Craxì Vito Di Marco Vincenza Calvaruso Giovanna Venezia Giovan Giuseppe Di Costanzo Alfonso Galeota Lanza Giovanni Di Perri Giuseppe Cariti Oscar Mollaretti Tiziano De Blasi Cumar Kulmiye Roberto Rostagno Patrizia Farci Maria Eliana Lai Giancarlo Serra Luchino Chessa Cinzia Balestrieri Cristiana Cauli Silvia Rossana Fargion Cristina Bertelli Erika Fatta Giovanna Fattovich Michela Pasino Silvia Zanni Nicola Olivari Irene Zagni Carlo Ferrari Simona Schivazappa Tiziana Giuberti Diletta Laccabue Amalia Penna Giovanbattista Gaeta Maria Stanzione Gianfranca Stornaiuolo Diego Martines Sara Boninsegna Giovanni Raimondo Gaia Caccamo Giovanni Squadrito Graziella Isgrò Mario Rizzetto Marco Lagget Silvia Carenzi Giuseppe Ruggiero Aldo Marrone Evangelista Sagnelli Vincenzo Messina Domenico Umberto Ulisse Di Caprio Vincenzo Selva Pierluigi Toniutto
      Gut 2012; 62 290-298 Published Online First: 02 Aug 2012. doi: 10.1136/gutjnl-2011-301430