title: Effect of nucleoside analog-interferon sequential therapy on patients with acute exacerbation of chronic hepatitis B.
abstract: OBJECTIVE
  Nucleoside analog (NA)-interferon (IFN) sequential therapy may enable the long-term control of chronic hepatitis B (CHB) and the withdrawal of the nucleoside analog. We evaluated the efficacy of NA-IFN sequential therapy for acute exacerbation of CHB.
  
  
  METHODS
  A total of 12 patients with acute exacerbation of CHB, nine of whom were positive for hepatitis B e antigen (HBeAg), were enrolled in this study. All the patients were treated with lamivudine 100 mg/day alone for 20 weeks, then with both IFN-alpha 6 megaunits three times per week and lamivudine for 4 weeks, and lastly, with IFN-alpha alone for 20 weeks. Patients whose serum alanine aminotransferase (ALT) level was normalized, whose serum hepatitis B virus (HBV) DNA level decreased to less than 5 log copies/mL, and HBeAg level was absent 24 weeks after the end of treatment were defined as having sustained virological response (SVR). The other patients were defined as having no response (NR).
  
  
  RESULTS
  Four out of nine (44.4%) HBeAg-positive and all three HBeAg-negative patients achieved SVR. The levels of serum alanine aminotransferase (ALT), HBV DNA and HBV core-related antigen were similar between SVR and NR patients at baseline. Three of four patients (75.0%) whose serum HBeAg became negative at the end of treatment achieved SVR, while one of five (20.0%) whose serum HBeAg remained positive achieved SVR.
  
  
  CONCLUSIONS
  NA-IFN sequential therapy for patients with acute exacerbation of CHB enables the withdrawal of treatment and is particularly effective for patients whose serum HBeAg has become undetectable by the end of the IFN treatment.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Okuse
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yotsuyanagi
authors.forename: Norie
authors.initials: N
authors.lastname: Yamada
authors.forename: Masaru
authors.initials: M
authors.lastname: Okamoto
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikeda
authors.forename: Minoru
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Hideaki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Nagase
authors.forename: Yuka
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Kotaro
authors.initials: K
authors.lastname: Matsunaga
authors.forename: Toshiya
authors.initials: T
authors.lastname: Ishii
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Matsumoto
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
authors.forename: Michihiro
authors.initials: M
authors.lastname: Suzuki
authors.forename: Fumio
authors.initials: F
authors.lastname: Itoh