Sequential combination therapy for chronic hepatitis B: More challenges to be tackled [7]
Journal
American Journal of Gastroenterology
Journal Volume
102
Journal Issue
7
Date Issued
2007
Author(s)
Abstract
TO THE EDITOR: We read with great interest the article entitled Effect of lowering HBV DNA levels by initial antiviral therapy before adding immunomodulator on treatment of chronic hepatitis null by Sarin et al. in the January 2007 issue (1). Currently, six agents have been approved for the treatment of chronic hepatitis B virus (HBV) infection, a leading cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma worldwide (2). However, the short-term efficacy of each agent alone or even simultaneous combinations of different agents remains unsatisfactory for both HBeAg-positive and -negative patients (3); it is thus key to identify new strategy to improve the rate of therapeutic response in chronic hepatitis B patients. In this article, the authors compared two treatment strategies in HBeAg-positive patients: 27 received placebo for 4 wk followed by PEG-IFN for the next 24 wk as group A, and 36 received lamivudine for 4 wk followed by PEG-IFN for the next 24 wk as group B. They found that at week 52, that is, 24 wk after the end of treatment, a higher percentage of patients in group B had undetectable serum HBV DNA (50% vs 15%, P = 0.028) and HBeAg loss (39% vs 15% P = 0.005) compared with group A. They therefore suggested that sequential combination therapy of initial direct antivirals before using immunomodulators may improve sustained responses in HBeAg-positive patients. Although their findings seem helpful to practicing physicians, several critical points need to be addressed before drawing definite conclusions.
SDGs
Type
letter