Pegylated interferon-α-2b combined with tenofovir disoproxil fumarate, granulocyte-macrophage colony-stimulating factor, and hepatitis B vaccine treatment for naïve HBeAg-positive chronic hepatitis B patients: A prospective, multicenter, randomized controlled study

J Med Virol. 2022 Nov;94(11):5475-5483. doi: 10.1002/jmv.28003. Epub 2022 Jul 19.

Abstract

Hepatitis B surface antigen (HBsAg) loss or seroconversion is an ideal treatment endpoint for patients with chronic hepatitis B but is rarely achievable in hepatitis B e-antigen (HBeAg)-positive patients using existing treatment strategies. In this study, the effect of pegylated interferon (peg-IFN) alfa-2b plus tenofovir disoproxil fumarate (TDF), granulocyte-macrophage colony-stimulating factor (GM-CSF), and hepatitis B vaccine was evaluated. This randomized controlled trial was conducted at nine liver centers in Chinese university hospitals from May 2018 to July 2020. Patients (n = 303) enrolled were randomly administered peg-IFN-α-2b combined with TDF, GM-CSF, and hepatitis B vaccine (experimental group); peg-IFN-α-2b plus TDF (control group 2); or interferon-α-2b alone (control group 1). The primary efficacy endpoint was HBsAg seroconversion at 48 weeks and the secondary endpoint included safety. No differences in baseline HBsAg levels were observed among the groups. The primary endpoint was achieved in three (3.0%), one (1.03%), and one (1.19%) patient in the experimental group, control group 2, and control group 1, respectively. The incidence of HBsAg seroconversion at week 48 was not significantly different among the three groups (p = 0.629). However, the decrease in serum levels of HBsAg at week 48 was significantly higher in the experimental and control group 2 compared with that in control group 1 (p = 0.008 and 0.006, respectively). No significant difference between the experimental and control group 2 was observed (p = 0.619). Adverse events were not significantly different among the groups except for the lower incidence of neutropenia in the experimental group. Peg-IFN-α-2b combined with TDF, GM-CSF, and hepatitis B vaccine is not superior to peg-IFN-α-2b combined with TDF in HBeAg-positive naïve patients. Clinical Trials Registration: ChiCTR1800016173.

Keywords: GM-CSF; chronic hepatitis B; functional cure; hepatitis B vaccine; pegylated interferon-alfa; tenofovir disoproxil fumarate.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiviral Agents
  • Granulocyte-Macrophage Colony-Stimulating Factor* / adverse effects
  • Hepatitis B Surface Antigens
  • Hepatitis B Vaccines* / adverse effects
  • Hepatitis B e Antigens
  • Hepatitis B, Chronic* / drug therapy
  • Hepatitis B, Chronic* / prevention & control
  • Humans
  • Interferon-alpha / adverse effects
  • Interferon-alpha / therapeutic use
  • Polyethylene Glycols
  • Prospective Studies
  • Recombinant Proteins / adverse effects
  • Tenofovir* / adverse effects
  • Tenofovir* / therapeutic use
  • Treatment Outcome

Substances

  • Antiviral Agents
  • Hepatitis B Surface Antigens
  • Hepatitis B Vaccines
  • Hepatitis B e Antigens
  • Interferon-alpha
  • Recombinant Proteins
  • Polyethylene Glycols
  • Granulocyte-Macrophage Colony-Stimulating Factor
  • Tenofovir

Associated data

  • ChiCTR/ChiCTR1800016173