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Published on: May 10, 2022
Retreatment hepatitis B surface antigen clearance prediction model identifies pegylated interferon alpha candidates
Yan-Chao Fu1, Jun Li2, Jia-Yin Wang1
1Department of Gastroenterology and Hepatology, Tianjin University Central Hospital (Tianjin Third Central Hospital), Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Institute of Hepatobiliary Disease, Tianjin 300170, China.
Background:
Chronic hepatitis B (CHB) patients rarely achieve functional cure with initial pegylated interferon alpha-2b (Peg-IFNα-2b) therapy. Validated tools to guide retreatment candidates are lacking. We hypothesized that clinical indicators predict hepatitis B surface antigen (HBsAg) clearance during retreatment.
Aim:
To develop a prediction model for HBsAg clearance in Peg-IFNα-2b retreatment.
Methods:
In this retrospective cohort study, we enrolled 135 CHB/compensated cirrhosis patients receiving Peg-IFNα-2b retreatment after initial non-clearance at Tianjin University Central Hospital (2017-2025). Predictors were identified through univariate Cox, least absolute shrinkage and selection operator, and multivariate Cox regression. Model performance was assessed via receiver operating characteristic analysis and Harrell's C-index, with risk stratification by X-tile optimization.
Results:
HBsAg clearance rate was 20.74% (28/135). Independent predictors included: Combination nucleos(t)ide analogue (NA) therapy during initial treatment [hazard ratio (HR) = 0.276, 95% confidence interval (CI): 0.092-0.833], baseline HBsAg at retreatment (HR = 0.571, 95%CI: 0.410-0.795), HBsAg decline after initial treatment (HR = 2.050, 95%CI: 1.108-3.793), and treatment interval (HR = 1.013/week, 95%CI: 1.008-1.018). The retreatment HBsAg clearance prediction score (RHCP-S) demonstrated area under the curve of 0.920 (95%CI: 0.863-0.946), sensitivity of 92.3%, specificity of 79.3%. Clearance rates differed significantly: RHCP-S challenge group (≤ 74 points): 3.45%, RHCP-S probable group (74-110 points): 29.63%, RHCP-S dominant group (≥ 110 points): 80.95% (P < 0.001).
Conclusion:
The overall HBsAg clearance rate with Peg-IFNα-2b retreatment was 20.74% (28/135). The RHCP-S model identifies optimal retreatment candidates (≥ 110 points) with 80.95% clearance probability, associated with the absence of combination NA therapy during initial treatment, greater initial HBsAg decline, longer intervals, and lower retreatment HBsAg.
