[Effect of interferon-alpha treatment in children with hepatitis B e antigen-positive chronic hepatitis B virus infection: a meta-analysis of follow-up for six months to two years].
OBJECTIVE
To assess the efficacy and safety of interferon-alpha (IFN-alpha) in children with Hepatitis B e antigen-positive chronic hepatitis B virus infection.


METHODS
PubMed and Chinese Biomedical Database were searched from the beginning of operation of the databases to April 2006, and the references of eligible studies were manually screened. Randomized controlled trials (RCTs) published in the English and Chinese literature comparing interferon-alpha with non-antiviral interventions (placebo or no treatment) in children with hepatitis B e antigen-positive chronic hepatitis B virus infection were eligible for inclusion. Studies were included if patients were treated for at least 3 months and followed-up for at least 6 months after cessation of therapy. Two investigators independently assessed the quality and extracted the data. The methodological quality of trails was assessed by the Jadad-scale plus allocation concealment. Heterogeneity was examined by Chi-square test. Fixed effects model or random effects model were used to pool the data. Sensitivity analyses were used for the treatment course.


RESULTS
Ten randomized controlled studies with a total of 542 children chronic HBV carriers who were positive for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) were identified. It was found by the meta-analysis that, compared with the control, at the end of the follow-up period, IFN-alpha could still significantly clear HBeAg [31.1% vs. 12.4%, odds ratio (OR): 3.17, 95% CI (2.00, 5.02), P < 0.000 01], clear HBV-DNA [33.9% vs. 16.2%, OR: 2.59, 95% CI (1.70, 3.96), P < 0.0001], clear HBsAg [5.5% vs. 1.2%, OR: 3.44, 95% CI (1.20, 9.89), P = 0.02], normalize ALT [43.0% vs. 27.7%, OR: 1.99, 95% CI (1.16, 3.42), P = 0.01], and achieve HBeAg seroconversion [30.4% vs. 12.8%, OR: 2.90, 95% CI (1.56, 5.39), P = 0.0008], but was not effective in HBsAg seroconversion [1.9% vs. 0, 95% CI (0.42, 18.13), P = 0.29].


CONCLUSIONS
Interferon-alpha might be efficacious in clearance of HBeAg, HBV-DNA and HBsAg, normalization of ALT, and achievement of HBeAg seroconversion in children with chronic hepatitis B. Little evidence is available on HBsAg seroconversion. Further RCTs of high-quality and sufficient number of cases are needed for confirmation of the clinical efficacy of IFN-alpha in chronic hepatitis B in children.
Lin
Zhi-qing
ZQ
Department of Pediatrics, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Fang
Feng
F
Guo
Zhi-feng
ZF
Chen
Qi
Q
D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis; D005500:Follow-Up Studies; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens / Q000032:analysis* / Q000302:isolation & purification; D006515:Hepatitis B virus / Q000187:drug effects*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007223:Infant; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D010919:Placebos; D016896:Treatment Outcome
D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D016898:Interferon-alpha; D010919:Placebos