Pegylated interferon-alpha toxicity mechanisms and management in chronic hepatitis B patients

This systematic review evaluated the mechanisms and management of adverse reactions associated with pegylated interferon-alpha in patients with chronic hepatitis B. The review addresses the drug's role as a cornerstone immunomodulatory therapy capable of achieving a functional cure for chronic hepatitis B. However, its clinical application is significantly constrained by a high frequency of multisystem adverse reactions arising from broad and often dysregulated systemic immune activation.

The identified adverse events include flu-like syndrome, cytopenias, autoimmunity, neuropsychiatric symptoms, and ocular vascular injury. Treatment discontinuation occurs frequently due to the high frequency of these multisystem adverse reactions, which constrain overall tolerability. The review notes that these toxicities are not ancillary effects but are direct consequences of the drug's therapeutic mechanism.

Key limitations include that the sample size was not reported, the setting was not reported, the comparator was not reported, the primary outcome was not reported, the follow-up duration was not reported, and funding or conflicts of interest were not reported. The certainty of the findings was not reported. Despite these gaps, the study provides a unified framework for understanding underlying host immunopathological mechanisms and contemporary management strategies.