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Treatment of children with HBeAg-positive chronic hepatitis B: A systematic review and meta-analysis

Published:September 04, 2014DOI:https://doi.org/10.1016/j.dld.2014.08.032

      Abstract

      Background

      Effective management of children with chronic hepatitis B is still an unresolved issue.

      Aim

      To assess the outcome of different therapeutic regimens among children with HBeAg-positive chronic hepatitis B.

      Methods

      Electronic database searches identified clinical trials that completed specific periods of treatment and follow-up. Sustained response rates were defined by the loss of HBV DNA and HBeAg, and by the normalization of liver enzymes. The loss of HBsAg and seroconversion to anti-HBs were also listed.

      Results

      Our searches found 20 eligible articles (1112 enrolled patients, 2–18 years old). Interferon-alpha therapy showed significantly higher sustained response rate and loss of HBsAg than no therapy (Odd's ratio 3.0, 95% confidence interval 1.6–5.4; and 2.3, 1.1–11.3, respectively). The sustained response rate was not significantly different between interferon and interferon plus lamivudine, or plus prednisone, or plus hepatitis B vaccine; this rate was significantly higher for interferon compared with combined interferon plus levamisole or vitamin E.

      Conclusion

      Interferon-alpha is still the most effective treatment option for children with HBeAg-positive chronic hepatitis B. Randomized trials are warranted for further comparing interferon to newer antiviral agents in terms of efficacy, safety, emergence of mutant variants, and cost/benefit ratio.

      Keywords

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