BASELINE HBSAG PREDICTS HBSAG LOSS AFTER 2 YEARS OF TREATMENT-FREE FOLLOW-UP IN CHRONIC HEPATITIS B PATIENTS TREATED WITH PEGINTERFERON ALFA-2A AND ADEFOVIR
L. Jansen1*, R.B. Takkenberg1, A. de Niet1, H.L. Zaaijer2,3, C.J. Weegink1, V. Terpstra4, M.G.W. Dijkgraaf5, R. Molenkamp6, P.L.M. Janssen1, M. Koot7, V. Rijckborst8, H.L.A. Janssen8, M.G.H.M. Beld1, H.W. Reesink1
1Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, 2Microbiology, Academic Medical Center (AMC), 3Blood Borne Infections, Sanquin, Amsterdam, 4Pathology, Bronovo Hospital, The Hague, 5Clinical Research Unit, 6Microbiology, Academic Medical Center, University of Amsterdam, 7Virus Diagnostic Services, Sanquin, Amsterdam, 8Gastroenterology and Hepatology, Erasmus MC, University Hospital Rotterdam, Rotterdam, The Netherlands. *l.***@****
Introduction and aim: Considering the low efficacy and significant side effects of peg-IFN based therapy, there is a need to establish predictors of response to allow selection of patients likely to benefit from treatment. Therefore we determined response and predictors of response in chronic hepatitis B patients treated with peg-IFN and adefovir combination therapy.
Patients and methods: We treated 92 chronic hepatitis B patients (44 HBeAg-positive and 48 HBeAg-negative) with HBV-DNA >100,000 copies/mL (>17,182 IU/mL) with peg-IFN and adefovir for 48 weeks, and followed them up for 2 years. Markers for HBeAg loss, combined response (HBV-DNA levels ≤ 2,000 IU/mL and ALT normalization), and HBsAg loss were evaluated. Serum HBsAg quantitation was performed by the Abbott Architect. Predictors of response were examined by logistic regression analysis.
Results: After 2 years of treatment free follow up, rates of HBeAg loss and HBsAg loss in HBeAg-positive patients were 18/44 (41%) and 5/44 (11%), respectively. Four of them developed anti-HBs. In HBeAg-negative patients, rates of combined response and HBsAg loss were 12/48 (25%) and 8/48 (17%), respectively. All but one HBeAg-negative patient with HBsAg loss had developed anti-HBs at 2 years of follow up. In HBeAg-positive patients no baseline markers predicted HBeAg- or HBsAg loss. HBeAg-negative patients with HBsAg loss had significantly lower baseline HBsAg levels than those without HBsAg loss (mean HBsAg 2.35 versus 3.55 log IU/mL, p < 0.001). They also had lower HBV-DNA levels and were more often (peg-) interferon experienced. Baseline HBsAg was the only independent predictor of HBsAg loss (OR 0.02, p = 0.01).
Conclusions: With combination therapy of peg-IFN and adefovir for 48 weeks, a high rate of HBsAg loss was observed in both HBeAg-positive (11%) and HBeAg-negative (17%) patients two years after end of treatment. In HBeAg-negative patients, a low baseline HBsAg level was a strong predictor for HBsAg loss.
Mr. Louis Jansen, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
Assigned in sessions:
26.04.2013, 09:00-18:00, Poster Session, P02-07c, Category 07c: Viral Hepatitis B & D: Clinical (therapy, new compounds, resistance), Poster Area