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 24 June 2017

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News

NIH consensus on antiviral therapy for adults with chronic Hep B

This month’s Annals of Internal Medicine reports on the National Institutes of Health Consensus Development Conference on antiviral therapy for chronic Hep B.

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Chronic Hepatitis B infection can lead to liver failure, hepatocellular carcinoma, and death.

Dr Tatyana Shamliyan and colleagues evaluated the effectiveness of antiviral therapy for adults with chronic Hepatitis B infection.

The team identified randomized, controlled trials of interferon, lamivudine, adefovir, entecavir, and telbivudine published from 1990 to 2008.

In addition, randomized, controlled clinical trials of adults with chronic Hepatitis B published in English after 1989 that reported death were assessed.

The team recorded the incidence of hepatocellular carcinoma or liver failure, prevalence and incidence of cirrhosis.

The presence or seroconversion of Hepatitis B e antigen or surface antigen, viral load of Hepatitis B virus DNA was also recorded.

Drug treatment did not improve clinical outcomes of chronic Hep B
Annals of Internal Medicine

The team measured aspartate aminotransferase and alanine aminotransferase levels.

Fibrosis scores after therapy with interferon-2b, pegylated interferon-2a, lamivudine, adefovir, entecavir, and telbivudine was assessed.

The team extracted data with standard protocols to calculate risk difference for clinical outcomes, viral load, Hepatitis B e antigen or surface antigen, alanine aminotransferase levels, histologic scores, and adverse events.

In 16 randomized controlled trials including 4431 patients, drug treatment did not improve clinical outcomes of chronic Hepatitis B infection.

However, the team reported that the trials were underpowered.

In 60 randomized controlled trials that examined intermediate outcomes, the team found no single treatment improved all intermediate outcomes.

Low-quality evidence suggested Hepatitis B e surface antigen clearance after interferon-2b, including 2 randomized controlled trials of 211 patients.

The team found that moderate-quality evidence suggested alanine aminotransferase levels normalization at follow-up after treatment with adefovir, and Hepatitis B e antigen loss with lamivudine.

With interferon-2b, moderate-quality evidence suggested Hepatitis B e antigen loss, seroconversion, and alanine aminotransferase levels normalization.

Pegylated interferon-2a versus lamivudine improved Hepatitis B e antigen seroconversion, and alanine aminotransferase levels normalization off treatment.

The team observed that pegylated interferon-2a combined with lamivudine versus lamivudine improved Hepatitis B e antigen loss, and alanine aminotransferase levels normalization.

Adverse events during antiretroviral therapy occurred in more than 50% of patients, but were not associated with increased treatment discontinuation.

However, the research team noted that most studies excluded patients with hepatic or renal insufficiency or other serious comorbid conditions.

Dr Shamliyan’s team concludes, “Evidence was insufficient to assess treatment effect on clinical outcomes or determine whether inconsistent improvements in selected intermediate measures are reliable surrogates.”

“Future research is needed to provide evidence-based recommendations about optimal antiviral therapy in adults with chronic Hepatitis B infection.”  

Ann Int Med 2009: 150(2)


08 January 2009

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