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Peg-interferon add-on to nucleoside analogues achieves HBsAg loss in 8.6% of patientsAdding peg-interferon to standard treatment helps some hepatitis B patients

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Key Takeaway
Note that 8.6% of patients achieved HBsAg loss with peg-interferon add-on to nucleoside analogue therapy.

This meta-analysis evaluates the efficacy of peg-interferon (peg-IFN) added to nucleoside analogue (NA) therapy in patients with chronic hepatitis B. The study included 581 patients and focused on HBsAg loss as the primary outcome at the end of follow-up, defined as 6 to 12 months after the conclusion of peg-IFN treatment.

Key findings indicate that 50 patients (8.6%) achieved HBsAg loss. Analysis by HBsAg levels at the end of follow-up showed 37.7% for HBsAg <100, 9.8% for 100 to 1000, and 2.3% for HBsAg $\geq$1000 (p<0.001). Additionally, the study reported HBsAg loss by ethnicity, with 30.0/8.7/3.6% for Caucasian and 39.3/9.2/2.2% for Asian patients across the three HBsAg levels.

For patients with high initial HBsAg ($\geq$1000), the study reported HBsAg <1000 at 24 weeks (29.7%) and 48 weeks (47.5%), with HBsAg <100 at 24 weeks (8.9%) and 48 weeks (16.3%). No safety data or specific limitations were reported in the source. Clinical application of these findings should be interpreted with caution due to the lack of reported safety outcomes and specific study limitations.

How this fits prior evidence

This meta-analysis addresses the management of chronic hepatitis B, a condition that carries a significantly higher risk for liver cancer than smoking-related lung cancer. While the study focuses on HBsAg loss via peg-interferon add-on, it follows previous evidence noting that immune markers correlate with outcomes following nucleoside analogue withdrawal. The findings regarding HBsAg loss rates in this meta-analysis provide specific data on the efficacy of combination therapy in this patient population.

Living with chronic hepatitis B means managing a long-term infection that requires consistent treatment. For many patients, the ultimate goal is to reach a point where the virus is no longer detectable in the blood. This is measured by a marker called HBsAg.

Researchers looked at 581 patients who were already taking nucleoside analogue therapy. They added peg-interferon to their routine to see if it helped them reach that goal. The results showed that 50 of those patients, or about 8.6 percent, successfully achieved HBsAg loss after their treatment period ended.

While the results show promise, the success rate varies depending on the starting levels of the virus. For example, patients starting with lower levels were more likely to reach the goal than those with very high levels. Because this data comes from a meta-analysis, it provides a broad look at how this combination works for different groups, including both Asian and Caucasian patients.

What this means for you:
Adding peg-interferon to standard therapy helps about 8.6% of patients achieve HBsAg loss.

Common questions

What is HBsAg loss and why does it matter?

HBsAg is a marker of the hepatitis B virus in your blood. Achieving HBsAg loss means the virus is no longer detectable. In this study, 50 out of 581 patients reached this goal after adding peg-interferon to their standard nucleoside treatment.

Does this treatment work for everyone with hepatitis B?

The success rate depends on the patient's starting levels. For example, 37.7% of patients with low initial levels (under 100) achieved HBsAg loss, while only 2.3% of those with very high levels (over 1000) reached that same goal.

Are there different results based on ethnicity?

The study looked at both Asian and Caucasian patients. Among those with low initial levels, 39.3% of Asian patients and 30.0% of Caucasian patients achieved HBsAg loss. You should talk to your doctor about which treatment path is best for you.

Study Details

Study typeMeta analysis
Sample sizen = 581
EvidenceLevel 1
Follow-up12.0 mo
PublishedSep 2026
View Original Abstract ↓
BACKGROUND: Peg-interferon (peg-IFN) plays an increasingly important role in HBV cure strategies, either in combination with novel antivirals, as a lead-in or as consolidation treatment. OBJECTIVE: We aimed to provide estimates of hepatitis B surface antigen (HBsAg) decline and clearance that can be achieved with peg-IFN addition to nucleos(t)ide analogue (NA) therapy. DESIGN: This is a post hoc meta-analysis of individual participant data from eight clinical trials involving chronic hepatitis B patients on NA therapy who received peg-IFN add-on. The primary endpoint was HBsAg loss at end of follow-up (EOF, 6-12 months after end of peg-IFN). Secondary analyses focused on HBsAg decline. RESULTS: 581 patients were included. At the start of peg-IFN therapy (SOT), 44% were hepatitis B envelope antigen (HBeAg) positive, mean HBsAg level was 3.03 log10 IU/mL (HBsAg<100: 12%; 100-1000: 28%; ≥1000: 60%), and planned duration of peg-IFN was 48 weeks in 496 patients (85%).At EOF, 50 (8.6%) patients achieved HBsAg loss (HBsAg<100/100-1000/≥1000: 37.7/9.8/2.3%, p<0.001) Findings were consistent across ethnicities (Caucasian: 30.0/8.7/3.6%; Asian: 39.3/9.2/2.2%). In patients with SOT HBsAg≥1000 IU/mL, levels <1000 and <100 were achieved in 29.7% and 8.9% at 24 weeks and in 47.5% and 16.3% at 48 weeks of peg-IFN therapy, respectively. CONCLUSION: Peg-IFN add-on results in HBsAg loss in 18% of patients with SOT HBsAg<1000 IU/mL, and in 38% if SOT HBsAg<100 IU/mL. Among patients with higher HBsAg levels, peg-IFN could be used to reduce HBsAg to below thresholds associated with response to novel compounds.
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