Peginterferon therapy for HBeAg-negative chronic hepatitis B: less than meets the eye

Pegylated interferon (PEG IFN) has been recommended as a first-line therapy for hepatitis B e antigen (HBeAg)-negative chronic hepatitis B; however, data supporting this recommendation are derived from a single randomized controlled trial. In this issue of the Journal, Rijckborst et al. report the results of a second randomized controlled PEG IFN trial in 138 HBeAg-negative patients. The trial was undertaken to test the efficacy of adding ribavirin to PEG IFN; however, the results were unequivocal in concluding that adding ribavirin was not effective. Moreover, the efficacy of PEG IFN for these HBeAg-negative subjects was disappointing; only 7.5% of the study cohort had undetectable hepatitis B virus DNA (<400 copies/ml) 24 weeks after a 48-week course of therapy, and none lost hepatitis B surface antigen. This study challenges the value and limits the appeal of PEG IFN therapy for HBeAg-negative chronic hepatitis B.