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Interferon-based optimal antiviral strategies in underage patients with chronic hepatitis B: A propensity
Limin Wang1, Meina Li2, Yi Dong3
1Department of Hepatopancreatobiliary Disease, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
Insights
For children with chronic hepatitis B (CHB), combining interferon (IFN) and nucleos(t)ide analogues (NA) at the start of treatment is more effective for HBsAg clearance than sequential therapy. Monotherapy with IFN also showed promise.
Area of Science:
- Hepatology
- Virology
- Pediatric Gastroenterology
Background:
- Chronic hepatitis B (CHB) treatment in children is crucial for hepatitis B elimination.
- Interferon (IFN)-based therapies are used for CHB, but real-world data on pediatric efficacy is limited.
Purpose of the Study:
- To evaluate the real-world effectiveness and safety of various interferon-based antiviral strategies in children with CHB.
- To compare HBsAg loss rates among different treatment regimens.
Main Methods:
- A cohort study included 809 CHB children with elevated ALT/AST and detectable HBV DNA.
- Propensity score weighted analysis (generalized overlap weighting and inverse probability of treatment weighting) was used.
- Serum hepatitis B surface antigen (HBsAg) loss was the primary outcome measure.
Main Results:
- De novo combination therapy with interferon (IFN) and nucleos(t)ide analogues (NA) and IFN monotherapy were more effective than sequential IFN-NA therapy.
- No significant difference in HBsAg loss was found between IFN monotherapy and de novo IFN-NA combination therapy.
- Serious adverse events were not observed in any treatment group.
Conclusions:
- Sequential IFN-NA treatment appears suboptimal for achieving HBsAg clearance in pediatric CHB patients.
- Initiating treatment with a combination of IFN and NA is favored based on this study's findings.
- This study represents the largest cohort to date evaluating these strategies in underage CHB patients.
Objectives:
Effective treatment of chronic hepatitis B (CHB) in childhood is critical to achieve the goal of eliminating hepatitis B. This study aims to assess the real-world efficacy and safety of different interferon(IFN)-based antiviral strategies in CHB children.
Methods:
CHB children with elevated ALT or aspartate aminotransferase (AST) and measurable HBV DNA were included. A propensity score weighted analysis was performed and rate of serum hepatitis B surface antigen (HBsAg) loss was the main outcome measure.
Results:
Totally, 809 patients were enrolled and divided according to different antiviral regimens, including 163 with IFN monotherapy, 325 with IFN-nucleos(t)ide analogues(NA) sequential therapy and 321 with de novo IFN and NA combination therapy. Mean age were 5.9 ± 4.0 years. Median follow-up time was 78.4 months. Generalized overlap weighting analysis showed that de novo IFN and NA combination therapy and IFN monotherapy were better than IFNNA sequential therapy but that no significant difference (P = 0.5999) existed between IFN monotherapy and de novo IFN and NA combination therapy. In the sensitivity analysis, the outcomes from inverse probability of treatment weighting were consistent with those from generalized overlap weighting, but no significant difference (P = 0.0605) was revealed between IFN monotherapy and IFNNA sequential therapy in the multivariable analysis using crude data. Serious adverse events were not observed among the patients.
Conclusions:
In this cohort study involving the hitherto largest sample of underage CHB patients, IFNNA sequential treatment, though it is commonly used, seems suboptimal in HBsAg clearance. Our results favour the combination of IFN and NA at inception.
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