Add -on of peg interferon to a stable nucleoside, hbsag loss 40%

[stef2011]

Add -on of peg interferon to a stable nucleoside regimen led to loss of HBs Ag in chronic hepatitis HBe Ag negative patients
D. Ouzan1; G. Penaranda2; H. Joly1; H. Khiri2; P. Halfon2
1. Institut Arnault Tzanck, Saint-Laurent du Var, France.
2. Laboratoire ALPHABIO, Marseille, France.

Objectives: Suppression of HBV viral load by nucleoside treatment reduces disease progression but requires indefinite treatment. Hbs Ag loss is a rare event after long term treatment with analogues therapy. In HBe Ag negative patients peg interferon alpha 2a for 96 weeks improved the sustained responses rate versus 48 weeks. It is of interest to know whether the addition of peg interferon for 96 weeks to a stable nucleoside therapy will reduce quantitative HBs-Ag which may follow by HBs Ag loss.
Methods: We analyzed HBs Ag levels of 10 patients who received additional peg

[stef2011]

yes they are very confusing and should not be used, at least for the hbsag which has small numbers.
2 logs is from 10 to 99iu/ml
3logs is from 1000 to 9999iu/ml
4logs is from 10.000iu/ml to 99999iu/ml

so 3.66logs should be between 5000 to 9999, may be about 7000iu/ml, i dont now if there is a way to make a precise number from 3.66log, i guess so, anybody expert with maths

[StephenCastlecrag]

I thought the figures were 2.90 log (10) fold and 4.25 log (10) fold which I took to mean reduction to 1/794 and 1/17782 - I am a bit confused about these log number.

[stef2011]

the combo of tdf+etv makes me think this combo is more potent than tdf or etv alone since  this patient had prior interferon non-response and only 10months from hbvdna und, she also had anti-hbs fast development and hbsag was high before peg addon:
During add-on therapy, in 2 patients a continuous decline of quantitative HBsAg by -2,6log10 (etv patient with hbsag 16iu/ml baseline) and -3,66 log10 (tdf+etv patient, high hbsag almost 4logs) was observed at week 32 and 36, respectively.

too bad they just say hbsag 3.66 logs which is between little lower than 10.000iu/ml and higher than 5000iu/ml.so definitely the combo of the most potent antivirals may have a relevance confirmed in bigger trials

[4est]

I don't know what of antivirals was used.

I think that a wide range of antivirals was used. In text they say about the 2 patients one on entecavir plus tenofovir and the second one on entecavir.

[4est]

"unfortuantely only gilead is funding very big trials with peginterferon add on that i know of" - is that so ?  I'm surprise that Gilead funding trials with peginterferon, because as I know  peginterferon is not a Gilead drug.

(maybe Gilead look for a compartation viread + peginterferon vs viread + GS 9620 or vs viread + Gilead vaccine )

[stef2011]

We observed that the add-on of peg-IFN induced HBsAg seroconversion in 2 out of 12 patients. Response rates may have been higher with prolongation of therapy. The add-on concept merits to be evaluated in a clinical trial........

i think so too, they just tried nas in general and even stopped too early in non responders, as they say in the conclusion they should have kept peginterferon for longer and use stronger tdf.another limit is they made tdf add-on too early.the french trial was made better reaching 40% response but also in that case they used adv and lam while the use of tdf or tdf+etv could have reached much higher rates already in 48weeks of combo

the new trials with tdf and peg add on have much better design but i think it is better not to wait for those results because in any case tdf and peg add on is the most potent therapy we have