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Comparison of Interferon-α-based therapy and nucleos(t)ide analogs in preventing adverse outcomes in patients with chronic hepatitis B - 12/01/22

Doi : 10.1016/j.clinre.2021.101758 
Qian-Guo Mao a, 1, , Hui-Qing Liang a, 1, , Ya-Lin Yin b, 1, Jin-Mo Tang a, Jia-En Yang a, Chun-Cheng Wu a, Yue Chen a, Man-Ying Zhang a, Yao-Yu Liu c, Xiao-Ting Zheng c, Lin-Yi Zhuang c, Shao-Dong Chen d,
a Xiamen Hospital of Traditional Chinese Medicine, Xiamen, 361009, China 
b School of Life Sciences, Xiamen University, Xiamen, 361102, China 
c College of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 351012, China 
d School of Medicine, Xiamen University, Xiamen, 361102, China 

Corresponding author at: Xiamen Hospital of Traditional Chinese Medicine, Xiamen, 361009, China.Xiamen Hospital of Traditional Chinese MedicineXiamen361009China⁎⁎Corresponding author at: School of Medicine, Xiamen University, Xiamen, 361102, China.School of MedicineXiamen UniversityXiamen361102China

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Highlights

IFN-α-based therapy was superior to NAs in preventing adverse outcomes in patients with CHB.
IFN-α in preventing HCC was more significant in patients with high-risk HCC.
IFN-α-based treatment was independently associated with a lower adverse outcomes incidence.

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Abstract

Background

Whether interferon (IFN)-α therapy is better than nucleos(t)ide analogs (NAs) in the prevention of adverse outcomes, including hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) is still uncertain or controversial. This study aimed to compare the cumulative incidence of adverse outcomes in patients with CHB on IFN-α- and NA-based therapies.

Methods

This was a retrospective study of patients with CHB on antivirals. Patients treated with IFN-α (IFN-α or peginterferon-α) with or without NAs were defined as the IFN-α group, and those only receiving NAs were defined as the NAs group. Propensity score matching (PSM) was used to minimize baseline bias. Cox regression models were performed to select possible factors related to adverse outcomes development.

Results

All 1247 patients were divided into the IFN-α (n = 877) and NAs (n = 370) groups. 26patients (20 and 6 in the NAs and IFN-α groups) developed adverse outcomes (decompensated cirrhosis, liver failure, HCC, liver transplantation and deaths) during a median follow-up of 5.2 years. The cumulative adverse outcomes occurrence at 10 years was significantly lower in the IFN-α group than in the NAs group in all (1.1% vs. 11.9%, P <0.001) and treatment-naïve (1.1% vs. 12.4%, P <0.001) patients. Similar trends were observed after PSM and differentiation of cirrhosis. Multivariate analysis before and after PSM showed that IFN-α-based treatment was independently associated with a lower adverse outcomes incidence (before/after PSM: P = 0.001/P = 0.002). HCC risk stratification analyses revealed that the superiority of IFN-α in preventing HCC was more significant in patients with high-risk HCC.

Conclusions

IFN-α-based therapy was superior to NAs in preventing adverse outcomes in patients with CHB regardless of cirrhosis, and in reducing HCC in those with a high risk of HCC.

Il testo completo di questo articolo è disponibile in PDF.

Key words : Chronic Hepatitis b, Hepatocellular carcinoma, Interferon-alpha, Nucleoside analogs, Antivirals


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