Treatment of children with HBeAg-positive chronic hepatitis B: a systematic review and meta-analysis
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Azza El Sherbini1, Asmaa Omar2
1Research Unit, Tanta Fever Hospital, Tanta, Egypt.
Insights
Interferon-alpha therapy is the most effective treatment for children with chronic hepatitis B (HBeAg-positive). It shows higher sustained response and HBsAg loss rates compared to no therapy.
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Virology
Background:
- Chronic hepatitis B in children remains a significant management challenge.
- HBeAg-positive status in pediatric chronic hepatitis B requires effective therapeutic strategies.
Purpose of the Study:
- To evaluate the effectiveness of various treatment regimens for HBeAg-positive chronic hepatitis B in children.
- To compare sustained response rates across different therapeutic interventions.
Main Methods:
- Systematic review of clinical trials involving pediatric patients (2-18 years) with chronic hepatitis B.
- Defined sustained response by HBV DNA loss, HBeAg loss, and normalized liver enzymes.
- Assessed additional outcomes including HBsAg loss and anti-HBs seroconversion.
Main Results:
- Interferon-alpha demonstrated significantly higher sustained response rates and HBsAg loss compared to no treatment.
- No significant difference in sustained response was observed between interferon-alpha and combinations with lamivudine, prednisone, or hepatitis B vaccine.
- Interferon-alpha showed superior sustained response rates compared to combinations with levamisole or vitamin E.
Conclusions:
- Interferon-alpha is currently the most effective treatment for pediatric HBeAg-positive chronic hepatitis B.
- Further randomized controlled trials are needed to compare interferon-alpha with novel antiviral agents, considering efficacy, safety, and cost-effectiveness.
Background:
Effective management of children with chronic hepatitis B is still an unresolved issue.
Aim:
To assess the outcome of different therapeutic regimens among children with HBeAg-positive chronic hepatitis B.
Methods:
Electronic database searches identified clinical trials that completed specific periods of treatment and follow-up. Sustained response rates were defined by the loss of HBV DNA and HBeAg, and by the normalization of liver enzymes. The loss of HBsAg and seroconversion to anti-HBs were also listed.
Results:
Our searches found 20 eligible articles (1112 enrolled patients, 2-18 years old). Interferon-alpha therapy showed significantly higher sustained response rate and loss of HBsAg than no therapy (Odd's ratio 3.0, 95% confidence interval 1.6-5.4; and 2.3, 1.1-11.3, respectively). The sustained response rate was not significantly different between interferon and interferon plus lamivudine, or plus prednisone, or plus hepatitis B vaccine; this rate was significantly higher for interferon compared with combined interferon plus levamisole or vitamin E.
Conclusion:
Interferon-alpha is still the most effective treatment option for children with HBeAg-positive chronic hepatitis B. Randomized trials are warranted for further comparing interferon to newer antiviral agents in terms of efficacy, safety, emergence of mutant variants, and cost/benefit ratio.
