INTERFERON - A METAANALYSIS OF PUBLISHED STUDIES IN PEDIATRIC CHRONICHEPATITIS-B

Perinatally infected Asian children respond poorly to interferon (IFN) therapy. In contrast, IFN therapy seems to be more effective in Cauca sian children who presumably acquired HBV infection later in Life. We reviewed seven controlled studies of IFN treatment in children with ch ronic hepatitis B living in western countries (216 treated, and 200 un treated children). Before treatment all patients were HBeAg and HBV-DN A +ve, with a biopsy proven chronic hepatitis B. Ages ranged 1 to 16 y ears (mean age 7 years). Most patients were Caucasian. Protocols which have been adopted may schematically be divided into protocols which h ave used high doses of IFN (7.5 to 10 MU/sqm/TIW), and protocols which have used low doses of IFN (3 to 6 MU/sqm/TIW), with a short (3 to 6 months) or a long duration of treatment (12 months). The percentage of treated patients who, at the end of treatment, lost HBV-DNA (that in most studies corresponded also to HBeAg serum conversion) averages 20 to 58% (mean 35.5%) that is much higher than that observed in controls (range 8-17%; mean 11.4%). A better trend is probably observed only i n patients who received the treatment for a longer period of time. At the end of treatment, low percentages of patients lost BsAg (range 0-4 %; mean 1.1%): again higher doses tend to be more effective than lower doses. In some studies IFN has been shown to significantly accelerate the termination of viral replication. Data on longer term outcome of IFN treatment in Caucasian children are scarce and confirm results obt ained at short and at medium-term FU either in horizontally either in perinatally infected children. Results from few randomized controlled trials of interferon therapy with prednisone priming in Chinese and Ca ucasian children were comparable to results obtained without prednison e. In one study steroid priming did not potentiate the effect of IFN, however it existed a tendency of prednisone to improve HBeAg clearance in patients with normal aspartate aminotransferase, and alanine amino transferase activity lesser than 100 u/l. In most studies, factors pos itively influencing response rates of IFN treatment are represented by severe inflammation in the basal liver biopsy, high basal levels of s erum transaminase, low basal levels of serum HBV-DNA. Vertical trasmis sion may be considered a factor adversely affecting the response to IF N treatment both in Chinese and Caucasian population. In general in mo st controlled studies, the majority of responders have shown a signifi cant reduction in hepatic inflammation and transaminase normalization. Children have a low risk of developing severe IFN-induced side effect s. Adverse reactions and worsening of health-related quality of life w ere tolerable and did not seem to be a limiting factor for IFN therapy in young candidates.