Safety and efficacy of interferon retreatment in children with chronic hepatitis B |
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| Authors: | A Ballauff T Schneider P Gerner P Habermehl R Behrens S Wirth |
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| Institution: | (1) Department of Paediatrics, University of Essen, Germany, DE;(2) Department of Paediatrics, University of Erlangen, Germany, DE;(3) Department of Paediatrics, University of Mainz, Germany, DE;(4) Kinderklinik der Klinikum Wuppertal GmbH, Heusnerstrasse 40, D-42283 Wuppertal, Germany, Tel.: +49-202-8962442, Fax: +49-202-8962519, DE |
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| Abstract: | More than 50% of children with chronic hepatitis B do not respond to treatment with alpha-interferon. Since these patients
continue to display high viral replication and progressive liver disease, retreatment should be considered. To date it has
not been well evaluated whether a second course of treatment could increase the response rate. In two alpha-interferon retreatment
trials in adult patients the response rate, defined by seroconversion from HBeAg to anti-HBe, ranged between 11% and 44%.
One beta-interferon retreatment study in children reported a seroconversion rate of 32%. Regrettably, none of the studies
included a control group observing the `spontaneous' seroconversion rate after a first interferon cycle. Thus, a nonrandomized
alpha-interferon retreatment study in children including control patients was performed. Alpha-interferon for retreatment
was administered 3 times a week for 16–24 weeks in 15 children (5–16 years) at least 6 months after ceasing the first cycle.
Four children received 5 MU/m2 of a natural alpha-interferon and 11 children 9 MU/m2 recombinant alpha-interferon 2b. Follow up was 18–47 months after initial treatment. In parallel, a control group of 19 un-retreated
children with comparable clinical and demographic data was followed for 12–39 months. HBeAg seroconversion was observed in
5 (33%) of the retreated children and in 5 (26%) of the control patients during follow up. The difference is not significant.
In the initially nonresponding children, those with high ALT levels before the first treatment showed late HBeAg seroconversion
more frequently than those with low ALT levels (P = 0.017) irrespective of retreatment. The ALT level before retreatment was not a predictor for response.
Conclusions A second cycle of alpha-interferon during the 3 years following the first treatment in nonresponding children with chronic
hepatitis B can be safely performed but did not increase HBeAg/anti-HBe seroconversion compared with the spontaneous seroconversion
rate of patients without retreatment.
Received: 29 July 1997 / Accepted in revised form: 23 October 1997 |
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| Keywords: | Chronic hepatitis B Children Alpha-interferon Non-responder Retreatment |
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