Efficacy of NAs in combination with Peg-IFN for functional cure in patients with CHB: a meta-analysis of RCTs.
Yaqin Zhang, Ziyu Zhang, Xinxin Li et al.
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In 30 seconds
This meta-analysis of 16 randomised controlled trials assessed nucleoside (acid) analogues (NAs) combined with pegylated interferon (Peg-IFN) for functional cure in people with chronic hepatitis B. Compared with NAs alone, combination therapy improved HBsAg clearance at end of treatment (EOT; RR 14.05, 95% CI 6.13-32.20) and end of follow-up (EOF; RR 7.70, 95% CI 4.24-13.98). It showed no additional functional-cure benefit over Peg-IFN alone at either time point. Peg-IFN monotherapy was associated with more ALT flares during treatment.
Key findings
- At EOT, HBsAg clearance was higher with NAs plus Peg-IFN than with NAs alone (RR: 14.05, 95% CI 6.13-32.20).
- At EOF, HBsAg clearance was higher with combination therapy than with NAs alone (RR: 7.70, 95% CI 4.24-13.98).
- Combination therapy did not improve HBsAg clearance, seroconversion, or qHBsAg decrease > 1 log10 IU/mL compared with Peg-IFN monotherapy at EOT or EOF.
- Peg-IFN monotherapy had more ALT flares (ALT > 5 × ULN) during treatment than combination therapy.
Why it matters
The findings distinguish the benefit of adding Peg-IFN to NAs from any incremental benefit over Peg-IFN alone. This comparison may inform interpretation of functional-cure outcomes and treatment trade-offs, while the reported ALT-flare difference highlights a safety outcome relevant to evaluating these regimens.