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

[ronny12]

Do you have any info what oral nucleoside was used? Because i think if all were priorily treated with tnf before peg add-on response rates would have been higher.

[4est]

http://www.ncbi.nlm.nih.gov/pubmed/22365367

- just a link for already presented case

[stef2011]

i think the we can have response from entecavir or tenofovir on hbsag as high as 1700-8000iu/ml but we need more data and bigger trials on use of tenofovir and entecavir and on hbsag at those ranges

unfortuantely only gilead is funding very big trials with peginterferon add on that i know of

[4est]

as calmama notice a big difference in terms of HbsAg can be notice in this two studys. 4,695  IU/ml (range 16-15,120) vs  660 IU/ml (range 50-1754) and iIwas wandering if the HbsAg level was a entry criteria for  the second case or if they use a different technology to measure.

somehow I think that the difference is to big

[stef2011]

these are my observation, weak antivirals like lam and adv take about 7 years to make interferon response work and 1 patient did not respond, these weak antivirals worked only with low hbsag less than 1000iu/ml

potent antivirals like entecavir and tenofovir worked even if treatment was short:
1 patient etv 3 years with very high hbsag about 8000iu/ml
1 patient tdf+etv 10 months hbsag not known
1 patient tdf 3 years, high hbsag around 1400iu/ml

so my guess is tenofovir is the most potent, etv+tdf even more potent and may shorten the time needed to get peginterferon response.etv and tdf can get peginterferon response even with high hbsag

what makes interferon response?i guess cccdna+intrahepatic hbvdna suppression because the longer you treat the lower cccdna, and also etv and tdf have little more decline on cccdna+intrahepatic hbvdna, combo etv+tdf even more cccdna+intrahepatic hbvdna suppression

we also know intrahepatic hbvdna suppress immune system, i think tests in serum are not reliable for this type of studies they should biopsy these patients to see hbsag quant, hbcag quant and cccdna hbvdna in the liver, i know it is difficult to obtain biopsy from patients but we do know serum tests dont show real status of the liver

as regards my treatment i will make tdf+etv+peg for sure, since this ******* virus doesn t respond so easily to treatment we must throw at him all we can, we do know all these combos have no sides....just expensive for insurance

[calmama]

A big difference between these two studies is their mean baseline HbsAg.  This one is 4,695 (range 16-15,120) IU/ml, while the previous study is 660 IU/ml range (50-1754).  About 10-fold difference there.  If the baseline HbsAg is a predicting factor of interferon treatment response (ie. HbsAg < 1500 iu/ml means more likely to respond), the results make sense.  

I just wonder how much HbsAg reduction would tenofovir or entecavir (or combo of the two) make after 3 years of antiviral treatment?  Is there such data published somewhere?