Gunstig langetermijneffect bij responders op interferonbehandeling onder patiënten met chronische hepatitis B in vergelijking tot non-responders; retrospectief onderzoek

To evaluate factors that influence clinical outcome and survival in chronic hepatitis-B patients treated with interferon alpha (IFNα).

Design

Retrospective.

Method

In a follow-up study of 165 hepatitis B e antigen (HBeAg)-positive patients who had been treated with IFNα in Rotterdam, the Netherlands, in 1978-2002, data were collected on general patient characteristics, immunologic response, viral load, alanine aminotransferase (ALAT) activity, liver histology, occurrence of decompensated cirrhosis and hepatocellular carcinoma, and survival.

Results

Median follow-up was 8.8 years (range: 0.3-23.9). 54 patients (33) responded to IFNα treatment, defined as HBeAg loss within 12 months after the end of IFNα therapy. 52 percent of the responders lost hepatitis B surface antigen (HBsAg) as compared to 9 of the non-responders (p < 0.001). Liver histology showed a decreased inflammatory activity and less progression of fibrosis in responders. Hepatocellular carcinoma was found in 8 patients, of whom 6 were non-responders. Of the 2 responders that developed hepatocellular carcinoma, 1 had relapsed after discontinuation of therapy. Multivariate analysis showed a significantly improved survival (relative risk (RR) of death: 0.28; 95 CI: 0.10-0.78) and reduced risk of developing hepatocellular carcinoma (RR: 0.084; 95 CI: 0.01-0.75) in responders.

Conclusion

Response to IFNα therapy resulted in a prolonged clinical remission with an increased rate of HBsAg seroconversion and improved liver histology. After correction for baseline factors, response to IFNα therapy was associated with increased survival and a reduced risk of developing hepatocellular carcinoma.

Ned Tijdschr Geneeskd 2005;149:1510-5