Efficacy Analysis Of Pegylated Interferon In Patients With Low-level HbsAg Chronic Hepatitis B Based On Real-world

Chronic hepatitis B virus(HBV)is widespread.According to World Health Organization(WHO)statistics,there are approximately 257 million chronic HBV patients worldwide,and about 887,000 people die from HBV infection-related diseases each year.There are about 70 million people with HBV infection in China,including about 20-30 million patients with chronic hepatitis B virus.Some patients will progress to end-stage liver diseases such as cirrhosis and liver cancer,accounting for approximately 77% and 84% of total cirrhosis and liver cancer patients[1-2].In the treatment of CHB,achieving HBs Ag clearance or seroconversion of HBs Ag is an ideal endpoint for antiviral therapy.HBs Ag is an important serum marker for HBV infection.Its level can be used to reflect the concentration of ccc DNA in the liver[6],and its spontaneous clearance is low.In current antiviral treatment regimens,both nucleoside analogs and interferons can achieve HBs Ag clearance,but the results are not satisfactory.In recent years several studies have shown that baseline HBs Ag levels and their decline can predict antiviral efficacy.In particular,the use of interferon for low levels of HBs Ag can significantly improve HBs Ag clearance[22,30].Therefore,88 CHB patients treated with pegylated interferon with HBs Ag <500IU / ml were selected in this study.By analyzing the clearance rate of HBs Ag and related factors will provide more evidence for the clinical treatment of low-level HBs Ag chronic hepatitis B with pegylated interferon.Method This retrospective study enrolled a total of 88 CHB patients with low HBs Ag levels(HBs Ag<500 IU/m L)who received pegylated interferon treatment for at least 24 weeks in Peking University Shen Zhen Hospital’s department Of Infectious Diseases from January 1,2017 to January 1,2019.To analyze the clearance rate of HBs Ag at 24 and 48 weeks and find out the related factors.Results1.Totally 88 patients were included,of which 45 people achieved HBs Ag clearance during the treatment period(0-48w).There were statistically significant differences in gender and baseline HBs Ag levels between the responding and non-responding groups(P <0.05);2.24 were treated with PEg-IFNα-2a and 21 were treated with PEg-IFNα-2b of the 45 people who achieved HBs Ag clearance.There was no statistical difference between the two groups(P = 0.195);3.Using univariate analysis for 25 patients with HBs Ag clearance at week 24 of treatment,which showed gender,HBe Ag status,and baseline HBs Ag levels were statistically significant(P=0.000,0.049,0.025).Using multivariate analysis showed that gender(OR = 8.950,95% CI = 1.967-40.731,p = 0.005)and HBs Ag baseline levels(OR = 0.991,95% CI = 0.983-1,p = 0.042)were statistically significant.4.Using univariate analysis for 10 patients with HBs Ag clearance at week 48 of treatment,which showed that age and 24-week’s HBs Ag falling percentage were statistically significant(p=0.047,0.009),multivariate analysis showed the decreased percentage of HBs Ag quantitation at week 24(OR = 1.063,95% CI =1.077-1.123,p = 0.027)could predict the efficacy at week 48.The area under the ROC curve of the percentage decrease in HBs Ag at week 24 was 0.786,(95% CI =0.639-0.934),the cut-off value is 61.147,the sensitivity was 100%,and the specificity was 45.9%,the positive predictive value was 30.3%,and the negative predictive value was 100%.Conclusions1.Baseline HBs Ag levels can be used to predict HBs Ag clearance after antiviral treatment;2.Patients with baseline HBs Ag <500 IU / m L who received pegylated interferon antiviral therapy achieved significantly higher HBs Ag clearance than those with high baseline levels;3.The effect of Peg-IFN α-2a is similar to that of Peg-IFN α-2b;4.The decrease in HBs Ag at week 24 during treatment can predict HBs Ag clearance at week 48.