Treatment of hepatitis B: Is there still a role for interferon?

Abstract

The treatment of chronic hepatitis B (CHB) patients is based on monotherapy with pegylated‐interferon (Peg‐IFN) or with one of the three most potent nucleot(s)ide analogues (NUCs) with the best resistance profiles, i.e. entecavir (ETV), tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF). Long‐term NUCs treatment can achieve virological suppression in almost all patients. However, this requires lifelong therapy, is costly and the rate of hepatitis B surface antigen (HBsAg) seroclearance is low. A one‐year course of Peg‐IFN has the advantage of providing immune‐mediated control of the hepatitis B virus (HBV) infection, the possibility of achieving a sustained off‐treatment response in nearly 30% of the patients and ultimately, HBsAg loss in approximately 30%‐50% of the latter patients during long‐term off treatment follow‐up. However, the major limitations to the extensive use of this treatment are the need for parenteral therapy and clinical and laboratory monitoring, the side‐effects profile and contraindications in certain patients and the limited effectiveness in a large proportion of patients. Nevertheless, the cost‐effectiveness of Peg‐IFN can be significantly increased by careful patient selection based upon baseline alanine aminotransferase (ALT), HBV DNA levels, viral genotype, host genetic variants and especially by applying early on‐treatment stopping rules based upon HBsAg kinetics. Recently, because of the different mechanisms of action of Peg‐IFN and NUCs, the strategy of “adding‐on” or “switching to” Peg‐IFN in patients being treated with NUCs to accelerate the decline in HBsAg and enhance HBsAg seroclearance rates, has provided interesting results.

 

KEYWORDS
antiviral treatment, hepatitis B virus, interferon

 

About Speaker

Pietro LAMPERTICO

Professor

Italy

City: Milan

Institution: Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan

Contact: pietro.lampertico@unimi.it


Biography of Pietro LAMPERTICO

Professor Pietro Lampertico is Assistant Professor in the 1st Gastroenterology Unit at the Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy, under the direction of Professor Massimo Colombo.

 

A 1986 graduate of the State University of Milan with degrees in medicine and surgery, Professor Lampertico completed his postdoctoral research in the Department of Experimental Pathology at Tulane University in New Orleans, USA. Upon his return to Milan, he completed specialisations in liver diseases and internal medicine. He received his PhD in clinical methodology from the University of Milan in 1998. In the Gastroenterology Unit, Professor Lampertico is primarily involved in the clinical management of chronic viral hepatitis outpatients, particularly those with CHB. His research interests include the treatment of patients with chronic hepatitis/cirrhosis due to HBV, the long-term outcome of cirrhotic patients undergoing antiviral treatment, and the diagnosis and management of antiviral resistance to oral nucleos(t)ide analogues.

 

Professor Lampertico is currently a reviewer for Gastroenterology, Hepatology, Gut, Journal of Hepatology and other top ranked journals, and a member of AASLD, EASL and AISF.

 

He has spoken internationally about liver disease, specifically the natural history of HBV and antiviral treatment, and has published several articles and book chapters. He is currently involved in national and international HBV clinical trials.

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