SNFGE SNFGE
 
Thématique :
- Foie
- Hépatites virales
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Jean-Marie PERON
Coup de coeur :
 
 
Gastroenterology
  2015/10  
 
  2015 Oct. pii: S0016-5085(15)01429-8  
  doi: 10.1053/j.gastro.2015.09.043  
 
  Combination of Tenofovir Disoproxil Fumarate and Peginterferon alfa-2a Increases Loss of Hepatitis B Surface Antigen in Patients with Chronic Hepatitis B  
 
  Marcellin P, Ahn SH, Ma X, Caruntu FA, Tak WY, Elkashab M, Chuang WL, Lim SG, Tabak F, Mehta R, Petersen J, Foster GR, Lou L, Martins EB, Dinh P, Lin L, Corsa A, Charuworn P, Subramanian GM, Reiser H, Reesink HW, Fung S, Strasser SI, Trinh H, Buti M, Gaeta GB, Hui AJ, Papatheodoridis G, Flisiak R, Chan HL; study 149 investigators  
  http://www.gastrojournal.org/article/S0016-5085%2815%2901429-8/abstract  
 
 

Background and aims
Patients chronically infected with the hepatitis B virus rarely achieve loss of serum hepatitis B surface antigen (HBsAg) with the standard of care. We evaluated HBsAg loss in patients receiving the combination of tenofovir disoproxil fumarate (TDF) and peginterferon alfa-2a (peginterferon), for a finite duration, in a randomized trial METHODS: In an open-label, active-controlled study, 740 patients with chronic hepatitis B were randomly assigned to receive TDF plus peginterferon for 48 weeks (group A), TDF plus peginterferon for 16 weeks followed by TDF for 32 weeks (group B), TDF for 120 weeks (group C), or peginterferon for 48 weeks (group D). The primary endpoint was the proportion of patients with serum HBsAg loss at week 72.

Results
At week 72, 9.1% of subjects in group A had HBsAg loss, compared with 2.8% of subjects in group B, none of the subjects in group C, and 2.8% of subjects in group D. A significantly higher proportion of subjects in group A had HBsAg loss than in group C (P<.001) or group D (P=.003). However, the proportions of subjects with HBsAg loss did not differ significantly between group B and group C (P=.466) or group D (P=.883). HBsAg loss in group A occurred in hepatitis B e antigen-positive and -negative patients with all major viral genotypes. The incidence of common adverse events (including headache, alopecia, and pyrexia) and treatment discontinuation due to adverse events was similar among groups.

Conclusion
A significantly greater proportion of patients receiving TDF plus peginterferon for 48 weeks had HBsAg loss than those receiving TDF or peginterferon alone. ClinicalTrials.gov no: NCT01277601.

 
Question posée
 
L’ajout d’interféron au ténofovir permet-il la perte de l’AgHBs ? 4 groupes de patients atteint d’hépatite chronique B dont 58% AgHBe +. Groupe A (ténofovir + interféron 48 semaines), groupe B (ténofovir + interferon 16 semaines puis ténofovir 32 semaines), groupe C (ténofovir 120 semaines), groupe D (interferon 48 semaines).
 
Question posée
 
Plus de perte de l’AgHBs (9,1 %) dans le groupe A (mais que 2,1 % séroconversions HBs).
 
Commentaires

Les patients Génotype A, AgHBs + sont ceux qui bénéficient le plus de l’ajout de l’interféron. Ce résultat est à mettre en balance avec les EI de l’interféron. Conséquence pratique minime voir nulle.

 
www.snfge.org