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首页> 外文期刊>International Journal of Environmental Research and Public Health >A Better Antiviral Efficacy Found in Nucleos(t)ide Analog (NA) Combinations with Interferon Therapy than NA Monotherapy for HBeAg Positive Chronic Hepatitis B: A Meta-Analysis
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A Better Antiviral Efficacy Found in Nucleos(t)ide Analog (NA) Combinations with Interferon Therapy than NA Monotherapy for HBeAg Positive Chronic Hepatitis B: A Meta-Analysis

机译：相对于NA单药治疗HBeAg阳性慢性乙型肝炎，在核苷类似物（NA）联合干扰素治疗中发现更好的抗病毒疗效：荟萃分析

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The clinical efficacy of nucleos(t)ide analogues (NAs) combined with interferon (IFN) therapy vs. NAs monotherapy for chronic hepatitis B (CHB) remains inconclusive. The aim of this meta-analysis was to determine whether the NAs plus IFN regimen offers synergistic efficacy that justifies the cost and burden of such a combination therapy in CHB patients. Methods: Related publications covering the period of 1966 to July 2014 were identified through searching MEDLINE, EMBASE, Cochrane library, Chinese Biomedical Literature Database, WANFANG, and CNKI database. A total of 17 studies were enrolled, including 6 in English and 11 in Chinese. Then, we established a final list of studies for the meta-analysis by systematically grading the quality and eligibility of the identified individual studies. We used hepatitis B antigen (HBeAg) loss, HBV-DNA undetectable rate, HBeAg seroconversion, hepatitis B surface antigen (HBsAg) loss, HBsAg seroconversion, and histological score at the end of treatment for efficacy evaluation. A quantitative meta-analysis (Review Manager, Version 5.1.0) was performed to assess the differences between NAs and IFN combination therapy and NAs monotherapy. Results: Our analysis demonstrated that HBeAg loss (RR = 1.73, 95% CI = 1.32–2.26, p < 0.001), HBV-DNA undetectable rate (RR = 1.58, 95% CI = 1.22–2.04, p < 0.001), HBeAg seroconversion (RR = 1.68, 95% CI = 1.36–2.07, p < 0.001), and HBsAg loss (RR = 2.51, 95% CI = 1.32–4.75, p < 0.001) in the combination therapy group were significantly higher than those in the monotherapy group. However, there were no significant differences in HBsAg seroconversion (RR = 4.25, 95% CI = 0.62–29.13, p = 0.14), sustained virological response rates, and biochemical response rates observed between the two groups. The results showed that the combination therapy group had more improved HBV histology than the NAs monotherapy group (RR = 1.14, 95% CI = 0.93–1.39, p = 0.22). Conclusions: NAs and IFN or Peg-IFN combination therapy had a better efficacy in terms of HBeAg loss, HBV-DNA undetectable rate, HBeAg seroconversion, and HBsAg loss, compared to the NA monotherapy group at the end of treatment; however, there was no significant difference in HBsAg seroconversion between the two regimens.
机译：核苷酸（t）ide类似物（NAs）联合干扰素（IFN）治疗与NAs单一治疗对慢性乙型肝炎（CHB）的临床疗效尚无定论。这项荟萃分析的目的是确定NAs加IFN方案是否具有协同效应，从而证明这种联合治疗在CHB患者中的成本和负担是合理的。方法：通过检索MEDLINE，EMBASE，Cochrane图书馆，中国生物医学文献数据库，WANFANG和CNKI数据库，确定1966年至2014年7月的相关出版物。总共招募了17项研究，包括英语6项和中文11项。然后，我们通过系统地对已鉴定的单个研究的质量和资格进行分级，从而建立了荟萃分析的最终研究清单。我们在治疗结束时使用了乙型肝炎抗原（HBeAg）丢失，HBV-DNA检出率，HBeAg血清转化，乙型肝炎表面抗原（HBsAg）丢失，HBsAg血清转化和组织学评分来评估疗效。进行定量荟萃分析（Review Manager，版本5.1.0）以评估NAs和IFN联合治疗与NAs单药治疗之间的差异。结果：我们的分析表明，HBeAg丢失（RR = 1.73，95％CI = 1.32–2.26，p <0.001），HBV-DNA检出率（RR = 1.58，95％CI = 1.22–2.04，p < 0.001），HBeAg血清转化（RR = 1.68，95％CI = 1.36–2.07，p <0.001）和HBsAg丢失（RR = 2.51，95％CI = 1.32–4.75，p <0.001）治疗组明显高于单一治疗组。但是，两组之间的HBsAg血清转化率（RR = 4.25，95％CI = 0.62–29.13，p = 0.14），持续的病毒学应答率和生化应答率均无显着差异。结果表明，联合治疗组的HBV组织学较NAs单一治疗组更好（RR = 1.14，95％CI = 0.93-1.39，p = 0.22）。结论：与NA单药治疗结束时相比，NAs和IFN或Peg-IFN联合治疗在HBeAg丢失，HBV-DNA不可检出率，HBeAg血清转换和HBsAg丢失方面具有更好的疗效;但是，两种方案之间的HBsAg血清转化没有显着差异。

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