Association of baseline alanine aminotransferase levels with therapeutic effects of entecavir and interferon-α in patients with chronic hepatitis B

XIAO Zhiqi; ZHOU Fuyuan; ZHOU Bin; YANG Jie

doi:10.12122/j.issn.1673-4254.2019.09.04

Abstract：Objective To evaluate the therapeutic effects of entecavir (ETV) and interferon-α (IFN-α) treatments for 48 weeks for chronic hepatitis B (CHB) in patients with different baseline alanine aminotransferase (ALT) levels.Methods We retrospectively analyzed the data of 369 CHB patients receiving ETV and IFN-α treatments for 48 weeks.We compared the virological response rates, HBsAg clearance, and HBsAg reduction between the patients receiving ETV and IFN-α treatments with different baseline ALT levels [≤5×upper limits of normal (ULN) level (subgroup 1), 5-10×ULN (subgroup 2), and＞10 ×ULN (subgroup 3) ].Results In patients receiving ETV treatment, the virological response rate was 83.3％ in subgroup 1, 91.4％in subgroup 2, and 95.5％ in subgroup 3, as compared with 19.7％, 40％, and 42.9％ in the 3 subgroups with IFN-α treatment, respectively, showing significantly differences both among different subgroups with the same treatment and between the same subgroup with different treatments (P＜0.05).HBeAg clearance rates in the 3 subgroups were 8.3％, 16.7％ and 35.5％ in patients with ETV treatment and were 1.8％, 41.9％, and 38.1％ in patients with IFN-α treatment, respectively, showing significant differences among the 3 subgroups with the same treatment (P＜0.05);in the same subgroups with different treatments, the rates differed significantly only between subgroups 2 (P＜0.05).In ETV group, the rate of HBsAg reduction to below 200 IU/ml was 2.5％ in subgroup 1 and 13.8％ in subgroup 2, showing no significant difference between the two subgroups;in IFN-αgroup, the rates were also similar between subgroups 1 and 2 (30.6％ vs 33.3％, P＞0.05);but the rates differed significantly between the same subgroups with different treatments (P＜0.05).Conclusion In all the subgroups with different baseline ALT levels, ETV treatment for 48 weeks results in significantly higher virological response rates than IFN-α treatment in patients with CHB.In patients with a baseline ALT of 5-10×ULN, IFN-α can result in a higher HBeAg clearance rate than ETV.In patients with comparable baseline ALT level, IFN-α more effectively reduces HBsAg level than ETV.The patients with a relatively high baseline ALT level (＞5×ULN) show better responses to both ETV and IFN-α treatment than those with ALT level below 5×ULN.We thus recommend IFN-αfor patients with a baseline ALT of 5-10×ULN and ETV for patients with a baseline ALT either below 5×ULN or beyond 10×ULN.