why is this no big news...sequential adv-interferon 50% hbsag negative

[stef2011]

Financial Support: None Potential Conflict of Interest: P. Marcellin advises, is a consultant for, and is on the speakers’ bureau of Roche, Schering-Plough, Gilead, Bristol-Myers Squibb, GlaxoSmithKline, and Idenix-Novartis. He is a consultant for and advises Vertex, Valeant, Human Genome Sciences, Cythesis, Intermune, Wyeth, and Tibotec.



Journal of Viral Hepatitis
Volume 18, Issue 8, pages 580–586, August 2011


Summary.  To assess the impact of sequential therapy with adefovir dipivoxil (ADV) and pegylated interferon alfa-2a (PEG-IFN) on virological (serum HBV-DNA) and serological (serum HBsAg) response in 20 consecutive HBeAg-negative patients. Patients received ADV for 20 weeks, then ADV and PEG-IFN for 4 weeks and lastly PEG-IFN for 44 weeks. Serum HBV-DNA and HBsAg were assessed at baseline, during therapy (weeks 20, 44 and 68) and follow-up (weeks 92 and 116). Sustained virological response (SVR) was defined as serum HBV-DNA <10 000 copies/mL (partial) or <70 copies/mL (complete) 24 weeks after stopping treatment. A serological response was defined as a serum HBsAg decrease ≥1 log10IU/mL at the end of treatment. Baseline median serum HBV-DNA and HBsAg levels were 7.6 log10copies/mL and 3.8 log10IU/mL, respectively. Ten patients (50%) achieved SVR, six of them had partial response and four complete response. Four patients (20%) achieved serological response. Complete SVRs showed a major and steep decline in HBsAg level with a median decrease of 0.5, 1.6 and 2.0 log10IU/mL at treatment week 20, 44 and 68, respectively. Partial SVRs showed a slight and slow decline in serum HBsAg level (0.1, 0.4, and 0.6 log IU/mL at weeks 20, 44 and 68, respectively). On-treatment serum HBsAg decrease had a high accuracy to predict SVR (AUROC = 0.88). Our results suggest that sequential therapy might be an interesting strategy for HBeAg-negative patients. Serum HBsAg kinetics seem to be an accurate tool to predict SVR. Large clinical trials are needed to explore this strategy with more potent analogues.

http://archive.mail-list.com/hbv_research/message/20110719.222458.ef93fd0d.en.html

[stef2011]

article is not written very clear, anyway the results should be as follows:

Ten patients (50%) achieved SVR, which usually is hbsag negative

of this 10 patients, 6 got hbsag negative without hbsab antibody and 4 got hbsag negative and hbsab positive

[stef2011]

considering that adv is very weak such a staggered interferon therapy with telbivudine, tenofovir or entecavir will have better results for sure, especially if interferon boosters like alinia, simvstatin and vitamin d are used

i think we are very close to the answer but too many years have been wasted without combo therapies that should have started from 2000 since none of the drugs showed any results on hbv monotherapy