Date of Graduation

Summer 8-9-2014

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

James Ferguson, PA-C, MS.

Second Advisor

Annjanette Sommers, PA-C, MS.

Abstract

Background: Chronic hepatitis B is a major health problem and may lead to cirrhosis, liver failure, liver cancer, and death if untreated. Interferon is currently better than nucleot(s)ide analogues in sustained seroconversion or loss of HBeAg and HBsAg. Peginterferon prolongs interferon’s effects. This review compared benefits and risks of peginterferon monotherapy versus peginterferon with lamivudine therapy in chronic hepatitis B.


Methods: Exhaustive search of medical literature was performed using key words peginterferon, peginterferon alfa-2a, peginterferon alfa-2b, lamivudine, and chronic hepatitis B, on EBMR Multifile, Evidence-Based Resources from the Joanna Briggs Institute, Medline-Ovid, and CINAHL. Qualities of relevant studies were assessed using the GRADE system.

Results: Three randomized controlled trials satisfied inclusion criteria and were included in this review. The first trial compared efficacy and safety between peginterferon alfa-2a alone, with lamivudine and lamivudine alone on 537 patients with HBeAg negative chronic hepatitis B. Regarding the viral suppression and the seroconversion of HBsAg, the groups on peginterferon were better than lamivudine alone; and no significant differences found between the peginterferon alone and the combination group. The second trial used the same three types of therapy groups on 814 patients with HBeAg positive chronic hepatitis B. Results were similar to the first study, plus similar rates of HBeAg loss or seroconversion between the two groups with peginterferon. The third trial used peginterferon alfa-2b alone or with lamivudine on 307 patients with HBeAg positive chronic hepatitis B, but final analysis accounted for 266 patients. Both treatment groups were not significantly different in the rates of responses and safety profile.

Conclusion: Peginterferon alfa-2a or alfa-2b could lead to HBsAg loss or seroconversion and sustained viral suppression in all chronic hepatitis B patients, and HBeAg loss or seroconversion in HBeAg positive patients. Peginterferon alone or with lamivudine showed similar responses and side effects. Peginterferon alfa-2a or alfa-2b were suggested as first line therapy for chronic hepatitis B. Future research is needed to evaluate the long-term responses of chronic hepatitis B to peginterferon alone or with lamivudine, the benefits of combining lamivudine to therapy, and the effects of peginterferon alfa-2b in HBeAg negative chronic hepatitis B patients.

Keywords: peginterferon, peginterferon alfa-2a, peginterferon alfa-2b, lamivudine, chronic hepatitis B.

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