Long‐term effect of interferon treatment on the progression of chronic hepatitis B: Bayesian meta‐analysis and meta‐regression

Aim: The long‐term effects of interferon treatment on the progression of chronic hepatitis B (CHB) have been studied extensively, but its true clinical benefits and the predictors of its efficacy remain unclear. Methods: A systematic published work search was undertaken. Eligible studies included those with interferon treatment and control groups, and with liver cirrhosis (LC), hepatocellular carcinoma (HCC) or death as main outcomes. Bayesian meta‐analysis and meta‐regression were performed to assess associations between interferon treatment and disease progression, and the impacts of potential covariates. Results: Eleven articles met the inclusion criteria. LC, HCC and death were end‐points in four, nine and six studies, respectively. In all studies, interferon was associated with significant preventive effects on HCC according to the DerSimonian–Laird method (relative risk [RR] = 0.470, 95% confidence interval [CI] = 0.260–0.850) and Bayesian method adjusting underlying risk (RR = 0.249, 95% Bayesian credible intervals [BCI] = 0.049–0.961), but not according to Bayesian meta‐analysis (RR = 0.274, 95% BCI = 0.059–1.031); and it showed similar effects in death but not in LC. However, most of the high‐quality studies never revealed protective benefits in these end‐points. Bayesian meta‐regression identified Asian ethnicity in death, higher hepatitis B e‐antigen (HBeAg) seroconversion rate or positivity rate, and length of follow up (≤5 years) in HCC as potentially protective against disease progression. Subgroup analysis confirmed similar effects from these factors in HCC and death. Conclusion: Additional evidence is needed to support the role of interferon in delaying CHB progression.