Interferon-alpha therapy in chronic hepatitis B: early monitoring of hepatitis B e antigen may help to decide whether to stop or to prolong therapy

Hepatitis B e antigen (HBeAg) was quantified before, during and after inter feron-alpha administration in a trial of 162 chronic hepatitis B patients t reated for 16 or 32 weeks. In 139 of these patients we examined the prognos tic value of the pretreatment level of HBeAg and the reduction in HBeAg lev el at weeks 4 and 8 for response at week 16. Multivariate analysis showed t hat the HBeAg pretreatment level is a highly significant predictor of respo nse (judged as HBeAg and hepatitis B virus [HBV] DNA negativity), followed by a decrease in HBeAg from the start of therapy to week 8. During the firs t 8 weeks of therapy, a decrease in HBeAg of less than 40%, as observed in 30% of the patients, consistently resulted in non-response. After 16 weeks of treatment, non-responding patients were randomly assigned to receive no further treatment (n=57) or prolonged treatment for another 16 weeks (n=61) . In both groups, changes in the HBeAg level from the start of (the first) therapy to week 8, but not the pretreatment HBeAg level itself, were signif icantly related to the response at week 52 (the end of follow-up). Changes in the HBV DNA level had no additional predictive value for response at wee ks 16 or 52. Therefore, instead of sequential HBV DNA assessment, we recomm end monthly monitoring of HBeAg during IFN-alpha therapy.