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The effectiveness of combination therapy with interferon and nucleoside analogs in pediatric patients with chronic hepatitis B: a systematic review and meta-analysis

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Abstract

Background

It is a challenging issue regarding the optimal antiviral treatment of children with chronic hepatitis B (CHB). The efficacy comparison of interferon (IFN) or nucleos(t)ide analogs (NAs) monotherapy with their combination could better understand this issue.

Methods

PubMed, EMBASE, Cochrane Library, Wanfang, CNKI, and abstracts of major international hepatology meetings were searched from inception to Feb 8, 2022. Randomized control trials and observational studies reporting the efficacy of combination therapy with IFN and NAs in children with CHB were eligible.

Results

A total of 17 studies were included. Compared with IFN monotherapy, combination therapy with IFN and NAs was significantly associated with increased rates of HBV DNA undetectable, HBeAg clearance, HBeAg seroconversion, alanine transaminase (ALT) normalization as well as the composite treatment response both at the end of treatment and during the follow-up period (RRs ranged from 1.23 to 1.75). A favorable trend for HBsAg seroconversion was found in IFN plus NAs-treated children, but not for the HBsAg clearance at the end of treatment. Although a similar trend towards the superiority of the combination therapy versus NAs monotherapy was observed (RRs ranged from 1.24 to 2.33) except for the HBV DNA undetectable rate at the end of treatment, the number of reported studies was limited.

Conclusions

Combination therapy with IFN and NAs is more effective than IFN monotherapy in viral suppression and serological response for children with CHB. More studies were still needed to reveal the efficacy of this combination therapy compared with NAs monotherapy.

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Acknowledgements

The authors would like to express their great appreciation to Dr. Jidong Jia for his guidance in data analyses and editing of the manuscript.

Funding

This work was supported by the High-level public health technical talents of the Beijing Municipal Health Commission (XUEKEGUGAN-010–018), and the National Natural Science Foundation of China-Youth Science Fund (No. 82103902).

Author information

Authors and Affiliations

  1. Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China

    Min Li & Yuanyuan Kong

  2. Beijing Clinical Research Institute, Beijing, China

    Min Li & Yuanyuan Kong

  3. National Clinical Research Center for Digestive Diseases, Beijing, China

    Min Li & Yuanyuan Kong

  4. Jumei Doctor Group, Beijing, China

    Qinghong Li, Jianhui Qu, Huiyin Yang & Hongfei Zhang

  5. Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China

    Tingting Lv

  6. Pediatric Hepatology, Hepatobiliary Pancreatic Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China

    Hongfei Zhang

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  1. Min Li
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  3. Jianhui Qu
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  4. Huiyin Yang
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Contributions

Study concept and design: Yuanyuan Kong, Hongfei Zhang. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Min Li. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: Min Li. Administrative, technical, or material support: Min Li, Tingting Lv. Study supervision: Yuanyuan Kong, Hongfei Zhang.

Corresponding authors

Correspondence to Yuanyuan Kong or Hongfei Zhang.

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Conflict of interest

Min Li, Qinghong Li, Jianhui Qu, Huiyin Yang, Tingting Lv, Yuanyuan Kong, Hongfei Zhang have no conflicts of interest.

Ethical approval

This study does not contain any studies with human participants or animals performed by any of the authors.

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Li, M., Li, Q., Qu, J. et al. The effectiveness of combination therapy with interferon and nucleoside analogs in pediatric patients with chronic hepatitis B: a systematic review and meta-analysis. Hepatol Int 17, 52–62 (2023). https://doi.org/10.1007/s12072-022-10415-7

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  • DOI: https://doi.org/10.1007/s12072-022-10415-7

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