Therapeutic effect of a low dosage of human leukocyte interferon on chronic hepatitis B virus infection

Experience with interferon in chronic hepatitis B in Egypt

Forty patients with compensated chronic active hepatitis B and elevated aminotransferases who were HBsAg and HBeAg positive were randomised to a treatment group receiving recombinant interferon alpha-2b (rIFN alpha-2b) or no treatment as a control group. The treated patients were divided into 2 groups, group I (n = 12) received IFN in a dose of 5 MU/m2 thrice weekly by subcutaneous injection for 16 weeks, and group II (n = 8) received the same dose daily for the same duration. Patients were followed up for 12 months after therapy ended. Initiation of IFN therapy was associated with an increase in aminotransferases, reaching a peak at 4-6 weeks in most patients, associated with clearance of HBeAg. At end of follow-up, 81% of the treated patients had cleared HBeAg vs 33% of the control group (p less than 0.01). Changes in other HBV markers were more frequent in the treated patients, though insignificantly. The type of response to therapy was significantly related to the duration of illness, being shortest in those who cleared HBsAg. A complete response to therapy with loss of HBsAg was associated with marked reduction in biochemical and histological activity. A partial response with clearance of HBeAg was associated with moderate improvement in biochemical parameters and ongoing activity in liver histology; whereas persistence of HBeAg was associated with elevated aminotransferases and histological deterioration in most cases. The rise in aminotransferases during seroconversion was associated with hepatic decompensation and death on 3 occasions: one during spontaneous seroconversion, and the other 2 during IFN therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Randomised controlled trial of lymphoblastoid interferon for chronic active hepatitis B

Thirty male patients (27 homosexual) with biopsy proven chronic active hepatitis B were randomised to receive lymphoblastoid interferon (Wellferon) or no treatment. All patients were HBeAg positive and had continuing viral replication. Patients receiving treatment were given a single daily intramuscular injection of interferon for 28 days at a starting dose of 2.5 MU/m2 increasing to a maximum of 7.5 MU/m2/day. Transient side effects of malaise and influenza like symptoms occurred in all patients and resolved rapidly after treatment. Hepatitis B viral replication was suppressed during interferon treatment in all patients but the effect was limited to the period of therapy. After one year there was no appreciable difference in viral markers between the two groups of patients and this treatment schedule appears less effective than the thrice weekly, three month regimes recently reported from other centres.

2',5'-Oligoadenylate synthetase activity in peripheral blood lymphocytes as a clinical marker in interferon therapy for chronic hepatitis B

Treatment of chronic hepatitis B (CHB) with human leukocyte interferon (IFN-alpha) was studied in terms of increase of 2',5'-oligoadenylate (2-5A) synthetase activity in peripheral blood lymphocytes (PBL) after IFN-alpha administration. The 2-5A synthetase activity in PBL increased to a maximum 16-24 h after IFN-alpha injection and then gradually decreased, while serum HB virus DNA polymerase (HBV-DNAP) activity, which corresponds to the amount of HBV virions in the serum, decreased to a minimum after about 48 h. Increase in 2-5A synthetase activity was followed about 1 day later by decrease in DNAP activity. Furthermore, of 9 patients treated with IFN for at least 22 weeks and observed for over 1 year after IFN treatment, the effective 5 cases in which HBeAg disappeared during IFN therapy and did not reappear showed rather high increases in 2-5A synthetase activity, whereas the ineffective 4 cases in which HBeAg remained positive at the end of IFN therapy showed little increases in enzyme activity. The present study suggests that prescreening by 2-5A synthetase assay before IFN therapy should be useful for obtaining better results in IFN treatment of CHB patients.

Interferons in the treatment of chronic hepatitis B virus infection

Hepatitis B virus offers several properties that may help to determine how antiviral substances, such as interferon, work. A description of the phases of chronic hepatitis B virus infection is presented, as well as the rationale for interferon therapy as treatment.

Lymphoblastoid alpha-interferon weekly, daily and combined with acyclovir for chronic HBeAg-positive hepatitis

Patients with chronic hepatitis B and active viral replication had no change in DNA-polymerase (DNA-p) and HBeAg when treated with weekly injections of lymphoblastoid alpha-interferon (IFN) for 4-10 weeks. Daily IFN (2.5 MU/m2 for a period of 4 weeks) was associated with a significant fall (P less than 0.05) in DNA-p but not in HBeAg; DNA-p remained or became negative in 3 out of 10 patients after stopping therapy. Combination of IFN and intravenous acyclovir (ACV, 15 mg/kg twice daily) led to a significantly greater fall in DNA-p and HBeAg, while tolerance of the combination therapy was excellent. Four out of 5 patients became DNA-p-negative and three HBeAg-negative; subsequently two became HBsAg-negative with anti-HBs. We conclude that weekly IFN appears ineffective. Daily IFN depressed hepatitis B virus replication, but does not change markedly the natural course of the disease. Combination therapy with ACV may be more effective than IFN alone and is well tolerated.

Treatment of hepatitis B surface antigen (HBsAg)-positive chronic hepatitis with recombinant leucocyte alpha-A interferon

A total of 32 individuals with HBsAg-positive and anti-delta-negative chronic hepatitis were treated with recombinant alpha-A interferon in phase I and phase II studies. In 5/32 patients HBsAg could be eliminated and in 19/32 individuals HBeAg became negative including all those who also eliminated HBsAg. Side-effects were tolerable in most patients and were readily reversible upon discontinuation of interferon therapy. In conclusion, treatment of HBsAg-positive chronic hepatitis with interferon seems to be a promising therapeutic approach. Future studies will have to establish the optimal dose, duration of treatment and factors predicting a favourable outcome of the treatment.