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Interferon treatment in children with chronic hepatitis B: an Israeli experience
Corina Hartman1, Hanoch Hager, Drora Berkowitz
1Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Rambam Medical Center, Haifa, Israel.
Insights
Interferon alpha (IFN alpha) treatment for chronic hepatitis B in children showed best results in those with high liver enzymes. Lower doses were less effective, and IFN alpha was not recommended for children with normal liver enzymes.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Virology
Background:
- Chronic hepatitis B (CHB) affects children worldwide.
- Interferon alpha (IFN alpha) is a treatment option for CHB.
- Limited data exists on IFN alpha efficacy in pediatric populations in Israel.
Purpose of the Study:
- To evaluate the effectiveness of interferon alpha (IFN alpha) in treating chronic hepatitis B (CHB) in children.
- To compare different dosages of IFN alpha and their outcomes.
- To assess the role of baseline liver enzyme levels in treatment response.
Main Methods:
- Retrospective review of 59 children with CHB.
- Treatment with subcutaneous IFN alpha at 10 MU/m or 5 MU/m for 6 months.
- Comparison with an untreated control group.
Main Results:
- Sustained biochemical and virologic response rates were 75% with 10 MU/m IFN alpha.
- Lower response rates (27% and 4%) were observed with 5 MU/m IFN alpha, depending on baseline ALT levels.
- Similar seroconversion rates were noted between treatment groups for children with elevated ALT, but not for those with normal ALT.
Conclusions:
- IFN alpha treatment outcomes in Israeli children align with international findings.
- The study supports current recommendations for using IFN alpha primarily in children with CHB and significantly elevated liver enzymes.
- Lower doses of IFN alpha showed limited efficacy, particularly in children with normal or mildly elevated ALT levels.
Objective:
To summarize the experience of two pediatric gastroenterology centers in northern Israel using interferon alpha to treat children with chronic hepatitis B.
Patients And Methods:
We retrospectively reviewed the medical records of 59 children with chronic HBV. Forty-nine children were treated with subcutaneous IFN alpha at dosages of 10 MU/m (n = 12) or 5 MU/m (n = 37) three times a week for 6 months. Children treated with 5 MU/m IFN alpha were a heterogeneous group with regard to their alanine aminotransferases levels: 11/37 (group 1) had ALT twice above the upper limit of normal and 26/37 (group 2) had normal or less than twice ULN elevations of ALT. Ten children were observed without treatment.
Results:
Sustained biochemical and virologic response occurred in 9/12 children (75%) treated with 10 MU/m IFN alpha, 3/11 (27%) in group 1 given 5 MU/m (P = 0.0315) and 4% (1/26) in group 2 treated with 5 MU/m. After 4 years follow-up, similar seroconversion rates were present in children who had baseline ALT higher than twice ULN, whether they were treated with 10 or 5 MU/m IFN alpha (83 vs. 73%). Children with normal or slightly abnormal baseline ALT also had a similar anti-hepatitis B e antigen seroconversion rate at the end of follow-up, whether they had been treated with IFN alpha or not (2/26, 8%, in group 2 and 4/10, 40%, in the untreated children, not significantly different).
Conclusions:
The results of IFN alpha treatment in this group of Israeli children are similar to these reported in the literature and reinforce the current consensus, which recommends INF alpha only for children with chronic HBV and significantly elevated liver enzymes.