Pegylated interferon alfa for chronic hepatitis B: systematic review and meta-analysis

Conventional interferon alfa and nucleos(t)ide analogues, such as lamivudine, are frequently used for chronic hepatitis B (CHB) treatment, but are associated with adverse effects and viral resistance. Here we performed a systematic review and meta-analysis evaluating all studies of pegylated interferon alfa (PEG-IFN) treatment in hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients with CHB. We searched electronic databases - PubMed, EMBASE, Cochrane Library and LILACS - for randomized controlled trials evaluating PEG-IFN therapy between 1999 and September 2014. Virological response was the primary outcome. We identified 14 studies involving 2829 patients. Our analysis revealed that PEG-IFN+lamivudine combination therapy produced better virological and biochemical responses than PEG-IFN monotherapy in HBeAg-positive and HBeAg-negative patients at the end of treatment. PEG-IFN+adefovir dipivoxil achieved better seroconversion rate than PEG-IFN in HBeAg-positive patients at the end of treatment. The present findings demonstrated a beneficial response rate following PEG-IFN combination therapy with nucelos(t)ides among HBeAg-positive and HBeAg-negative patients with CHB. Further trials are needed to investigate simultaneous and sequential therapy strategies.