Long‐term outcome of hepatitis B e antigen–positive patients with compensated cirrhosis treated with interferon alfa

• Published in: Hepatology (Baltimore, Md.) Vol. 26; no. 5; pp. 1338 - 1342
• Main Authors: Fattovich, G, Giustina, G, Realdi, G, Corrocher, R, Schalm, S W
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.11.1997; Wiley
• Subjects: Biological and medical sciences; Immunomodulators; Medical sciences; Pharmacology. Drug treatments; Human; Concentration factor; Alpha interferon; Liver; Hepatic disease; Long term; Result; Infection; Hepatitis B e antigen; Viral hepatitis B; Cirrhosis; Enzymatic activity; Viral disease; Immunotherapy; Digestive diseases; Complication; Evolution; Biological effect
• DOI: 10.1002/hep.510260536
• ISSN: 0270-9139

The aim of this study was to evaluate whether interferon alfa (IFN‐α) treatment‐associated virological and biochemical remission improves survival in a cohort of 90 white patients with compensated cirrhosis caused by hepatitis B (Child A) followed for a mean period of 7 years. Inclusion criteria were biopsy‐proven cirrhosis, hepatitis B e antigen (HBeAg) positivity, abnormal serum aminotransferase levels, exclusion of hepatitis delta virus, and absence of complications of cirrhosis. Of the 40 IFN‐treated patients, 27 (67%) showed sustained HBeAg loss with alanine aminotransferase (ALT) normalization. Of the 50 untreated patients, 30 (60%) cleared HBeAg, but only 21 (42%) normalized ALT after HBeAg loss. Compared with the untreated patients, IFN‐treated patients had similar cumulative rates of HBeAg clearance (P = .48), but higher rates of ALT normalization (P = .016) and of HBsAg loss (P = .028). During follow‐up, liver‐related death occurred in 8 treated patients, caused by liver failure in 5 and hepatocellular carcinoma (HCC) in 3; all 8 had continued to be HBeAg‐positive with elevated ALT. None of the treated patients undergoing remission developed liver‐related complications. At univariate analysis, life expectancy was longer in treated patients showing sustained remission than in those who did not (5‐year survival: 100% vs. 81%; P = .048). Fourteen untreated patients died (from liver failure in 10 and HCC in 4); all but 3 had continued to be HBeAg‐positive with elevated ALT. Cox's model identified age and ALT normalization as the only significant predictors of survival. In conclusion, in patients with HBeAg‐positive compensated cirrhosis, virological and biochemical remission following IFN therapy is associated with improved survival.