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Evidence summaries

Sequential Combination of Glucocorticosteroids and Alfa Interferon Versus Alfa Interferon Alone for Hbeag-Positive Chronic Hepatitis B

Pretreatment with glucocorticosteroids before treatment with alfa interferon in patients with hepatitis B 'e' antigen positive chronic hepatitis B may be more effective than treatment with alfa interferon alone with regard to loss of hepatitis B 'e' antigen and hepatitis B virus DNA, but evidence for effect on clinical outcomes is lacking. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 13 studies with a total of 790 subjects. Loss of hepatitis B 'e' antigen (OR 1.41, 95% confidence interval 1.03 to 1.92, P = 0.03) and hepatitis B virus DNA (OR = 1.51, 95% confidence interval 1.12 to 2.05, P = 0.008) were significantly more frequent among patients treated with the sequential combination of glucocorticosteroids and alfa interferon than among patients treated with alfa interferon alone. Glucocorticosteroid pretreatment did not significantly influence seroconversion from hepatitis B 'e' antigen to antibodies to hepatitis B 'e' antigen, loss of hepatitis B surface antigen, normalisation of transaminase activities, and severity of adverse events. Glucocorticosteroid pretreatment did not significantly affect mortality (total number of reported deaths were four - two in each intervention group) and adverse events.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by indirectness (differences in studied patients).

    References

    • Mellerup MT, Krogsgaard K, Mathurin P, Gluud C, Poynard T. Sequential combination of glucocorticosteroids and alfa interferon versus alfa interferon alone for HBeAg-positive chronic hepatitis B. Cochrane Database Syst Rev 2005 Jul 20;(3):CD000345. [PubMed]

Primary/Secondary Keywords