AUTHOR=Wei Na , Zheng Bin , Cai Hongfu , Li Na , Yang Jing , Liu Maobai 

TITLE=Systematic review and meta-analysis: de novo combination of nucleos(t)ide analogs and pegylated interferon alpha versus pegylated interferon alpha monotherapy for the functional cure of chronic hepatitis B

JOURNAL=Frontiers in Pharmacology

VOLUME=15

YEAR=2024

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2024.1403805

DOI=10.3389/fphar.2024.1403805

ISSN=1663-9812

ABSTRACT=<p><bold>Introduction:</bold> Chronic hepatitis B (CHB) is a worldwide infectious disease caused by hepatitis B virus (HBV). Optimizing antiviral treatment strategies could improve the functional cure (FC) rate of patients with CHB. This study aims to systematically review the FC rate of the <italic>de novo</italic> combination of nucleos(t)ide analogs (NAs) and pegylated interferon α (PEG-IFNα) versus that of PEG-IFNα monotherapy for CHB.</p><p><bold>Methods:</bold> Databases were searched until 31 December 2023. Selected studies included randomized controlled trials on the <italic>de novo</italic> combination of NAs and PEG-IFNα versus PEG-IFNα monotherapy for 48 weeks in patients with CHB to achieve FC, which was defined as hepatitis B surface antigen (HBsAg) loss and/or HBsAg seroconversion. Meta-analysis was conducted in accordance with the efficacy at the end of treatment and different time points during follow-up.</p><p><bold>Results:</bold> A total of 10 studies, encompassing 2,339 patients in total, were included. Subgroup analysis was conducted in accordance with whether first-line NAs were used. It found no statistically significant difference between HBsAg loss and HBsAg seroconversion at the end of treatment. Serum HBV DNA &lt;500 copies/mL significantly differed between the two groups at the end of treatment and did not significantly differ during follow-up. Meanwhile, HBsAg loss and HBsAg seroconversion showed statistically significant differences at 24 weeks of follow-up. By contrast, no statistically significant difference was found in HBsAg loss at 48 weeks of follow-up.</p><p><bold>Discussion:</bold> Without distinguishing the eligible preponderant population, the efficacy of the <italic>de novo</italic> combination of NAs and PEG-IFNα in treating patients with CHB was not superior to that of PEG-IFNα monotherapy.</p><p><bold>Systematic Review Registration:</bold> PROSPERO, identifier CRD42022325239.</p>