HBeAg Decrease during Treatment Predicts Sustained Response to Pegylated Interferon for Chronic Hepatitis B

Levels of hepatitis B "e" antigen (HBeAg) during treatment may be a more accurate predictor than hepatitis B surface antigen (HBsAg) or HBV viral load for determining which patients will respond to pegylated interferon for chronic hepatitis B, according to a study from Thailand published in the March 2010 issue of Hepatology Research.

Pisit Tangkijvanich from Chulalongkorn University in Bangkok and colleagues compared the clinical applicability of 3 serological measures for predicting virological response to pegylated interferon among patients with hepatitis B: HBsAg, HBeAg, and HBV DNA (viral load).

The study included 30 initially HBeAg positive chronic hepatitis B patients who received pegylated interferon alfa-2b (PegIntron) for 48 weeks. Quantitative HBsAg, HBeAg, and HBV DNA were measured before, during, and after therapy. In addition, paired before and after liver biopsies were analyzed for the presence of intrahepatic HBV DNA and covalently closed circular DNA (cccDNA).

Virological response was defined as both HBeAg seroconversion and HBV DNA < 10 000 copies/mL at 48 weeks after completion of treatment.

Results

• 10 participants (33.3%) achieved virological response by both criteria at 48 weeks post-treatment.
• Responders had significantly lower baseline levels of HBsAg, HBeAg, intrahepatic HBV DNA, and cccDNA compared with non-responders.
• Baseline and reduced levels of HBsAg and HBeAg correlated well with those of total intrahepatic HBV DNA and cccDNA.
• Responders showed consistent decreases in serum levels of HBsAg, HBeAg, and HBV DNA during therapy.
• An HBeAg decrease of at least 2-fold at week 24 of therapy was the best predictor of sustained virological response.
• Sensitivity of 24-week HBeAg was 85% and negative predictive value was 92%.
• 1 participant (3.3%) who achieved HBsAg clearance at follow-up experienced more rapid decline in serum HBsAg during therapy than those who achieved virological response without HBsAg clearance.

Based on these findings, the study authors concluded, "Quantitative measurement of serum HBeAg during therapy may be superior to serum HBsAg and HBV DNA as a prediction of HBeAg seroconversion."

"Kinetics of HBsAg levels on therapy may help predict HBsAg clearance after treatment," they suggested.

Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Departments of Biochemistry and Medicine and Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

6/4/10

Reference

P Tangkijvanich, P Komolmit, V Mahachai, and others. Comparison between quantitative hepatitis B surface antigen, hepatitis B e-antigen and hepatitis B virus DNA levels for predicting virological response to pegylated interferon-alpha-2b therapy in hepatitis B e-antigen-positive chronic hepatitis B. Hepatology Research 40(3): 237-345 (Abstract). March 2010.